Provider Demographics
NPI:1720263726
Name:FAHED, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FAHED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAJDI
Other - Middle Name:
Other - Last Name:FAHED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25691 E INDORE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3108 S PARKER RD STE D6
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3179
Practice Address - Country:US
Practice Address - Phone:720-923-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist