Provider Demographics
NPI:1932452612
Name:PTASKIEWICZ, TINA VANHESS (RPH)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:VANHESS
Last Name:PTASKIEWICZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 W CEDAR DR
Mailing Address - Street 2:#210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1975
Mailing Address - Country:US
Mailing Address - Phone:303-763-5533
Mailing Address - Fax:
Practice Address - Street 1:12860 W CEDAR DR
Practice Address - Street 2:#210
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1975
Practice Address - Country:US
Practice Address - Phone:303-763-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13676183500000X
TX31289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist