Provider Demographics
NPI:1134529704
Name:POLLOCK, DERRY ROBERT (MT(ASCP), CLS(NCA))
Entity type:Individual
Prefix:MR
First Name:DERRY
Middle Name:ROBERT
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MT(ASCP), CLS(NCA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 WEST JEWELL AVE
Mailing Address - Street 2:APT 19-203
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-4835
Mailing Address - Country:US
Mailing Address - Phone:575-302-2407
Mailing Address - Fax:
Practice Address - Street 1:10555 WEST JEWELL AVE
Practice Address - Street 2:APT 19-203
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-4835
Practice Address - Country:US
Practice Address - Phone:575-302-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist