Provider Demographics
NPI:1891131934
Name:JATTA, SAMBOU S (PHARMACIST (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SAMBOU
Middle Name:S
Last Name:JATTA
Suffix:
Gender:M
Credentials:PHARMACIST (PHARMD
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:S
Other - Last Name:JATTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST (PHARMD
Mailing Address - Street 1:2201 S MOLINE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4913
Mailing Address - Country:US
Mailing Address - Phone:720-748-7766
Mailing Address - Fax:
Practice Address - Street 1:2201 S MOLINE CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4913
Practice Address - Country:US
Practice Address - Phone:720-748-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist