Provider Demographics
NPI:1467808501
Name:KHAMSEH KORDOUNI, FATEMEH (PHARMD)
Entity Type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:KHAMSEH KORDOUNI
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 1:4920 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1236
Mailing Address - Country:US
Mailing Address - Phone:720-480-0432
Mailing Address - Fax:
Practice Address - Street 1:363 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1522
Practice Address - Country:US
Practice Address - Phone:303-733-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist