=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306707559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ODELIS COLON COLON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 S 76TH ST
-----------------------------------------------------
City | GREENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53129-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-978-9019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2049 S 72ND ST
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53219-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2328740
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------