MEDICARE: COLORADO STATE UNIVERSITY

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	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy	PDO0990000010	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2001415	OTHER		PK

General Provider Information

NPI Number	:	1871519918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	151 W LAKE ST SUITE 1100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-8031
Country	:	US
Telephone Number	:	970-491-1402
Fax Number	:	970-491-4874

Provider Business Practice Location Address
First Line	:	151 W LAKE ST SUITE 1100
Second Line	:	COLORADO STATE UNIVERSITY
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-8031
Country	:	US
Telephone Number	:	970-491-1402
Fax Number	:	970-491-4874

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MICHELE D BROWN
Credential	:	PHARMD
Telephone Number	:	970-491-1402

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/17/2025

Similar Medicare Providers

1467449843 — MR. MARK EDWARD DEYSHER MPT, OCS
Practice Location Address:

151 WEST LAKE STREET
FORT COLLINS, CO
80523-8031

Practice Phone: 970-491-1719
Practice Fax: 970-491-5306

1164460127 — HOWARD CHRIS YURK D.D.S.
Practice Location Address:

COLORADO STATE UNIVERSITY - HARTSHORN HEALTH SERVI , HARTSHORN BUILDING (8031)
FORT COLLINS, CO
80523-0001

Practice Phone: 970-491-1710
Practice Fax:

1033153804 — MS. WANDA ELAINE KELLEY NURSE PRACTITIONER
Practice Location Address:

COLORADO STATE UNIVERSITY HARTSHORN HEALTH SERVICE , 8031 CAMPUS DELIVERY
FORT COLLINS, CO
80523-0001

Practice Phone: 970-491-7121
Practice Fax: 970-491-0268

1457395188 — DR. LAURIE LYNN ELWYN M.D.
Practice Location Address:

HARTSHORN HEALTH SERVICE , COLORADO STATE UNIVERSITY
FORT COLLINS, CO
80523-8031

Practice Phone: 970-491-7121
Practice Fax: 970-491-3956

1407892037 — CAROL M MILLER PT
Practice Location Address:

8031 CAMPUS DELIVERY , COLORADO STATE UNIVERSITY
FORT COLLINS, CO
80523-8031

Practice Phone: 970-491-1735
Practice Fax:

1023027778 — DR. KATHLENE SUE WALLER M.D.
Practice Location Address:

HARTSHORN HEALTH SERVICE , COLORADO STATE UNIVERSITY
FORT COLLINS, CO
80523-8031

Practice Phone: 970-491-7121
Practice Fax: 970-491-0226

Directions to “COLORADO STATE UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.