Provider Demographics
NPI:1679874291
Name:FIORENZI, ROBERT DAVID (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:FIORENZI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-9405
Mailing Address - Country:US
Mailing Address - Phone:719-846-4785
Mailing Address - Fax:
Practice Address - Street 1:457 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2623
Practice Address - Country:US
Practice Address - Phone:719-846-3086
Practice Address - Fax:719-846-4087
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11312OtherCOLORADO PHARMACY LICENSE