Provider Demographics
NPI:1104786680
Name:ROUSSEAU, EMILY (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 E 19TH AVE APT 219
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-5523
Mailing Address - Country:US
Mailing Address - Phone:314-518-2722
Mailing Address - Fax:
Practice Address - Street 1:1600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1923
Practice Address - Country:US
Practice Address - Phone:303-398-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist