Healthcare Provider Details

I. General information

NPI: 1932435500
Provider Name (Legal Business Name): JENNELL N COLWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

702 BARNHILL DR
INDIANAPOLIS IN
46202-5128
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2335
  • Fax:
Mailing address:
  • Phone: 317-278-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26022842A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: