Provider Demographics
NPI:1306216973
Name:LABORDO, MARLYSE ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARLYSE
Middle Name:ANN
Last Name:LABORDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 ROSLYN ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2310
Mailing Address - Country:US
Mailing Address - Phone:626-353-8863
Mailing Address - Fax:
Practice Address - Street 1:4850 E 62ND AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-3288
Practice Address - Country:US
Practice Address - Phone:303-288-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist