Provider Demographics
NPI:1821472762
Name:RAZA, KALYN STACEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:STACEY
Last Name:RAZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-5019
Mailing Address - Country:US
Mailing Address - Phone:303-537-9809
Mailing Address - Fax:
Practice Address - Street 1:10400 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-5019
Practice Address - Country:US
Practice Address - Phone:303-537-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022674183500000X
AZS021308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist