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NPI Code Detail

MEDICARE: COLLEEN M. COLEGROVE R.PH.

MEDICARE: COLLEEN M. COLEGROVE R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH017478GA
2183500000XPharmacist168417AK

General Provider Information

NPI Number : 1124160049
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN M. COLEGROVE R.PH.
Provider Business Mailing Address
First Line : 19137 NUNIVAK CIR
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-8660
Country : US
Telephone Number : 706-768-5689
Fax Number :
Provider Business Practice Location Address
First Line : 2550 E 88TH AVE
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-3814
Country : US
Telephone Number : 907-349-9292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 02/24/2021

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