Provider Demographics
NPI:1265125777
Name:BIZARRO, KAYLEIGH MARIE (CPHT)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MARIE
Last Name:BIZARRO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9976 HOUGH PT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9555
Mailing Address - Country:US
Mailing Address - Phone:908-403-9911
Mailing Address - Fax:
Practice Address - Street 1:7370 LAGAE RD
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9509
Practice Address - Country:US
Practice Address - Phone:720-214-2283
Practice Address - Fax:720-214-2289
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHAT.0015967183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician