Healthcare Provider Details

I. General information

NPI: 1861249195
Provider Name (Legal Business Name): COLBY MATTHEW BOIRE PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 STATE ROUTE 11
CHAMPLAIN NY
12919
US

IV. Provider business mailing address

17 MOUNTAIN VIEW DR
ROUSES POINT NY
12979-1631
US

V. Phone/Fax

Practice location:
  • Phone: 518-299-5466
  • Fax: 518-299-5467
Mailing address:
  • Phone: 518-536-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0134923
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: