Provider Demographics
NPI:1578777868
Name:GHIORSO, PETER MICHAEL (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:MICHAEL
Last Name:GHIORSO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 S POPLAR ST
Mailing Address - Street 2:#104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1388
Mailing Address - Country:US
Mailing Address - Phone:303-756-8468
Mailing Address - Fax:
Practice Address - Street 1:6460 E YALE AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7156
Practice Address - Country:US
Practice Address - Phone:303-691-8874
Practice Address - Fax:303-691-0557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14040183500000X
CARPH23336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist