Provider Demographics
NPI:1790447415
Name:DEHKORDI, NASIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:NASIM
Middle Name:
Last Name:DEHKORDI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NASIM
Other - Middle Name:
Other - Last Name:DEHKORDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:20051 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3135
Mailing Address - Country:US
Mailing Address - Phone:720-876-0919
Mailing Address - Fax:
Practice Address - Street 1:20051 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3135
Practice Address - Country:US
Practice Address - Phone:720-876-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.00237761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist