Provider Demographics
NPI:1245000181
Name:NEKOUEI, KEYVAN
Entity type:Individual
Prefix:
First Name:KEYVAN
Middle Name:
Last Name:NEKOUEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 E VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6476
Mailing Address - Country:US
Mailing Address - Phone:303-888-4148
Mailing Address - Fax:
Practice Address - Street 1:19015 E VASSAR DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6476
Practice Address - Country:US
Practice Address - Phone:303-888-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist