Provider Demographics
NPI:1043654379
Name:WOLDU, EDEN (RPH)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:WOLDU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18605 GREEN VALLEY RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6832
Mailing Address - Country:US
Mailing Address - Phone:303-371-8985
Mailing Address - Fax:303-371-1586
Practice Address - Street 1:18605 GREEN VALLEY RANCH BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6832
Practice Address - Country:US
Practice Address - Phone:303-371-8985
Practice Address - Fax:303-371-1586
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO147871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist