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General NPI Number Information
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NPI Number | 1215537469
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Entity Type | Individual
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Provider Name | BRIDGET LEE COLOMBO
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 141 N DEAN AVE
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City | RAYMORE
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State | MO
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Zip | 64083-8398
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Country | US
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Telephone | 816-425-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 18900 S PROSPECT AVE
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City | BELTON
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State | MO
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Zip | 64012-9633
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Country | US
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Telephone | 785-220-1439
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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 | 2012024150
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License Number State | MO
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