Provider Demographics
NPI:1962090746
Name:ALEKSEJEV, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:ALEKSEJEV
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 1:3739 S JEBEL WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6607
Mailing Address - Country:US
Mailing Address - Phone:303-875-6871
Mailing Address - Fax:
Practice Address - Street 1:645 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5926
Practice Address - Country:US
Practice Address - Phone:303-867-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist