Provider Demographics
NPI:1144503731
Name:KOUMA, DAVID R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:KOUMA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 W EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3150
Mailing Address - Country:US
Mailing Address - Phone:970-612-0243
Mailing Address - Fax:970-612-0246
Practice Address - Street 1:2370 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3150
Practice Address - Country:US
Practice Address - Phone:970-612-0243
Practice Address - Fax:970-612-0246
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist