Provider Demographics
NPI:1760046445
Name:NICOLARSEN, DENNIS SCOTT
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:SCOTT
Last Name:NICOLARSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7983 S FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3256
Mailing Address - Country:US
Mailing Address - Phone:303-552-8262
Mailing Address - Fax:
Practice Address - Street 1:13420 W COAL MINE AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5402
Practice Address - Country:US
Practice Address - Phone:303-979-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist