MEDICARE: NASIM DEHKORDI PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PHA.0023776	CO

General Provider Information

NPI Number	:	1790447415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASIM DEHKORDI PHARMD

Provider Business Mailing Address
First Line	:	20051 E SMOKY HILL RD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3135
Country	:	US
Telephone Number	:	720-876-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	20051 E SMOKY HILL RD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3135
Country	:	US
Telephone Number	:	720-876-0919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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