MEDICARE: DR. PAUL MARVIN ATHEY PHARM.D.,RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13955	CO
2	183500000X	Pharmacist	9609	NE

General Provider Information

NPI Number	:	1164588547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MARVIN ATHEY PHARM.D.,RPH

Provider Business Mailing Address
First Line	:	6556 MYRTLE CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4097
Country	:	US
Telephone Number	:	402-578-9629
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 HARTSEL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4165
Country	:	US
Telephone Number	:	719-590-7515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/02/2016

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