Provider Demographics
NPI:1063960185
Name:DASHA, GINBAR
Entity type:Individual
Prefix:
First Name:GINBAR
Middle Name:
Last Name:DASHA
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 1:1300 S WILLOW ST APT 9308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2157
Mailing Address - Country:US
Mailing Address - Phone:510-759-9060
Mailing Address - Fax:
Practice Address - Street 1:1300 S WILLOW ST APT 9308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2157
Practice Address - Country:US
Practice Address - Phone:510-759-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74712183500000X
CO0021216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist