Provider Demographics
NPI:1225818966
Name:PRINDAVONG, PIDCHAYA (PHARM D)
Entity type:Individual
Prefix:
First Name:PIDCHAYA
Middle Name:
Last Name:PRINDAVONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 W WOODARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2480
Mailing Address - Country:US
Mailing Address - Phone:720-280-5331
Mailing Address - Fax:
Practice Address - Street 1:1545 S KIPLING PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6236
Practice Address - Country:US
Practice Address - Phone:303-989-8490
Practice Address - Fax:303-969-3026
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist