Provider Demographics
NPI:1447779897
Name:DELZER, LUKE MATTHEW (PHARM D)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:MATTHEW
Last Name:DELZER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 PROMINENT PEAK HTS APT 212
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-8637
Mailing Address - Country:US
Mailing Address - Phone:719-238-8764
Mailing Address - Fax:
Practice Address - Street 1:4105 BRIARGATE PKWY # 125
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3480
Practice Address - Country:US
Practice Address - Phone:800-218-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist