Provider Demographics
NPI:1790169753
Name:KOOGLE, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:KOOGLE
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 1:6100 S GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5262
Mailing Address - Country:US
Mailing Address - Phone:303-400-4880
Mailing Address - Fax:303-400-4883
Practice Address - Street 1:6100 S GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5262
Practice Address - Country:US
Practice Address - Phone:303-400-4880
Practice Address - Fax:303-400-4883
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist