Provider Demographics
NPI:1457646093
Name:KOLIMAGA, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KOLIMAGA
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 1:7930 NORTHFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3527
Mailing Address - Country:US
Mailing Address - Phone:303-209-8721
Mailing Address - Fax:303-209-8721
Practice Address - Street 1:7930 NORTHFIELD BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3527
Practice Address - Country:US
Practice Address - Phone:303-209-8721
Practice Address - Fax:303-209-8721
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18672183500000X
AZ15732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist