Provider Demographics
NPI:1043972938
Name:TESFAY, ROBEL KIDANE
Entity Type:Individual
Prefix:
First Name:ROBEL
Middle Name:KIDANE
Last Name:TESFAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 S COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6618
Mailing Address - Country:US
Mailing Address - Phone:303-757-2365
Mailing Address - Fax:
Practice Address - Street 1:2870 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6618
Practice Address - Country:US
Practice Address - Phone:303-757-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist