Provider Demographics
NPI:1730818006
Name:EHIZUELEN, EHIABHI KINGSLEY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:EHIABHI
Middle Name:KINGSLEY
Last Name:EHIZUELEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KINGSLEY
Other - Middle Name:EHIABHI
Other - Last Name:EHIZUELEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6758 S CATAWBA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5943
Mailing Address - Country:US
Mailing Address - Phone:720-545-7470
Mailing Address - Fax:
Practice Address - Street 1:16290 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1594
Practice Address - Country:US
Practice Address - Phone:303-699-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171631835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care