Healthcare Provider Details

I. General information

NPI: 1881133775
Provider Name (Legal Business Name): NOLAN KOLLER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ARGONNE RD
SPOKANE VALLEY WA
99212-2600
US

IV. Provider business mailing address

2525 E 53RD AVE APT A208
SPOKANE WA
99223-9133
US

V. Phone/Fax

Practice location:
  • Phone: 509-534-4300
  • Fax:
Mailing address:
  • Phone: 509-751-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH 60547425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: