Provider Demographics
NPI:1417390030
Name:NIKMANESH, MARYAM
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:
Last Name:NIKMANESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7984 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3025
Mailing Address - Country:US
Mailing Address - Phone:303-914-2061
Mailing Address - Fax:303-914-2071
Practice Address - Street 1:7984 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3025
Practice Address - Country:US
Practice Address - Phone:303-914-2061
Practice Address - Fax:303-914-2071
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist