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General NPI Number Information
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NPI Number | 1205431871
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Entity Type | Individual
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Provider Name | SHELBY NICOLE COLGLAZIER
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 2800 ENTERPRISE ST STE 5
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-1106
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Country | US
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Telephone | 866-779-1696
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Fax |
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Provider Business Mailing Address
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Address Line | 7541 SOUTHERN LAKES DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9380
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Country | US
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Telephone | 812-620-4667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26028301A
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License Number State | IN
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