Provider Demographics
NPI:1447622253
Name:KRAKAUSKAS, PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:KRAKAUSKAS
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 1:2930 SIMMS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-7032
Mailing Address - Country:US
Mailing Address - Phone:303-593-1101
Mailing Address - Fax:
Practice Address - Street 1:2930 SIMMS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-7032
Practice Address - Country:US
Practice Address - Phone:303-593-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0020861183500000X
PARP036672L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist