Healthcare Provider Details

I. General information

NPI: 1508266180
Provider Name (Legal Business Name): CHRISTOPHER COLGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 N MAIN ST
LAS CRUCES NM
88001-1164
US

IV. Provider business mailing address

2877 CHEYENNE DR
LAS CRUCES NM
88011-5232
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-8878
  • Fax:
Mailing address:
  • Phone: 860-885-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82074
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9921
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35740
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11980
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: