MEDICARE: MR. CHRISTOPHER KOLODY PHARM.D.

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	P6029	ID

General Provider Information

NPI Number	:	1366720948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER KOLODY PHARM.D.

Provider Business Mailing Address
First Line	:	2400 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-463-2903
Fax Number	:	208-468-0215

Provider Business Practice Location Address
First Line	:	2400 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-463-2903
Fax Number	:	208-468-0215

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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