Provider Demographics
NPI:1063888709
Name:ARYAL, PRASIDDHA
Entity type:Individual
Prefix:
First Name:PRASIDDHA
Middle Name:
Last Name:ARYAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1511
Mailing Address - Country:US
Mailing Address - Phone:303-744-8660
Mailing Address - Fax:303-282-5013
Practice Address - Street 1:323 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1511
Practice Address - Country:US
Practice Address - Phone:303-744-8660
Practice Address - Fax:303-282-5013
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist