MEDICARE: KATHRYN COLEGROVE

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	RP0010257	WV
2	183500000X	Pharmacist	03237289	OH

General Provider Information

NPI Number	:	1841894128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN COLEGROVE

Provider Business Mailing Address
First Line	:	4207 GALLIA ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-5512
Country	:	US
Telephone Number	:	740-456-4158
Fax Number	:	740-456-4958

Provider Business Practice Location Address
First Line	:	4207 GALLIA ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-5512
Country	:	US
Telephone Number	:	740-456-4158
Fax Number	:	740-456-4958

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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Directions to “ KATHRYN COLEGROVE ” Practice Location

Language	Start Address	Practice Location

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