Provider Demographics
NPI:1629411863
Name:POLYCARPOU, DINA H
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:H
Last Name:POLYCARPOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-9118
Mailing Address - Country:US
Mailing Address - Phone:720-981-4610
Mailing Address - Fax:720-981-5895
Practice Address - Street 1:6760 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4574
Practice Address - Country:US
Practice Address - Phone:303-979-2180
Practice Address - Fax:303-979-0949
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist