Healthcare Provider Details

I. General information

NPI: 1720533607
Provider Name (Legal Business Name): SARAH ELLANA COLWELL RPH., PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 W FAIRVIEW AVE
BOISE ID
83702-6722
US

IV. Provider business mailing address

3654 N PRICE WAY
MERIDIAN ID
83646-2747
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-2676
  • Fax:
Mailing address:
  • Phone: 520-220-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: