Healthcare Provider Details

I. General information

NPI: 1164588547
Provider Name (Legal Business Name): PAUL MARVIN ATHEY PHARM.D.,RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 CONSTITUTION AVE
COLORADO SPRINGS CO
80951-8901
US

IV. Provider business mailing address

7915 CONSTITUTION AVE
COLORADO SPRINGS CO
80951-8901
US

V. Phone/Fax

Practice location:
  • Phone: 719-284-6274
  • Fax: 719-284-6278
Mailing address:
  • Phone: 719-284-6274
  • Fax: 719-284-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number13955
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13955
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9609
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: