Provider Demographics
NPI:1497367866
Name:FOUKS, SERGEY I (PHARMD, MSHSA)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:I
Last Name:FOUKS
Suffix:
Gender:M
Credentials:PHARMD, MSHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 S BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3012
Mailing Address - Country:US
Mailing Address - Phone:720-404-2989
Mailing Address - Fax:
Practice Address - Street 1:449 S BALSAM ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3012
Practice Address - Country:US
Practice Address - Phone:720-404-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0023189OtherDORA