Provider Demographics
NPI:1447778667
Name:KLIDARAS, PHILOSTRATOS (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILOSTRATOS
Middle Name:
Last Name:KLIDARAS
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 1:5765 N GENOA WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2075
Mailing Address - Country:US
Mailing Address - Phone:720-683-8719
Mailing Address - Fax:
Practice Address - Street 1:15310 E 104TH AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8607
Practice Address - Country:US
Practice Address - Phone:303-928-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist