Provider Demographics
NPI:1851128896
Name:JAIN, DIVYA (PHARMD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:JAIN
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 1:11621 PINE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8318
Mailing Address - Country:US
Mailing Address - Phone:303-406-8015
Mailing Address - Fax:
Practice Address - Street 1:16920 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9102
Practice Address - Country:US
Practice Address - Phone:303-805-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0024910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist