Provider Demographics
NPI:1740581214
Name:ANDERSON, KELVIN CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:CHRISTIAN
Last Name:ANDERSON
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 1:21314 E. 53RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249
Mailing Address - Country:US
Mailing Address - Phone:720-838-5690
Mailing Address - Fax:
Practice Address - Street 1:1677 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5007
Practice Address - Country:US
Practice Address - Phone:303-481-2291
Practice Address - Fax:303-481-2283
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist