Provider Demographics
NPI:1093157406
Name:IMSIROVIC, EMILY DEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DEE
Last Name:IMSIROVIC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DEE
Other - Last Name:STENSRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7593 E TECHNOLOGY WAY
Mailing Address - Street 2:APT 115
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16601 E CENTRETECH PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9045
Practice Address - Country:US
Practice Address - Phone:563-343-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0019925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist