Provider Demographics
NPI:1346949062
Name:GARZA, DENNIS MATTHEW
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MATTHEW
Last Name:GARZA
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 1:766 S MARTIN ST APT A122
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6095
Mailing Address - Country:US
Mailing Address - Phone:956-740-6490
Mailing Address - Fax:
Practice Address - Street 1:9970 WADSWORTH PKWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4248
Practice Address - Country:US
Practice Address - Phone:303-439-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist