Provider Demographics
NPI:1790100923
Name:CASSIDY, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CASSIDY
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 1:9100 E FLORIDA AVE
Mailing Address - Street 2:#8-202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14200 E ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1402
Practice Address - Country:US
Practice Address - Phone:303-214-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19789183500000X
CA67468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist