Provider Demographics
NPI:1063612133
Name:COLBERT, MARYLEIGH NICHOLS (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARYLEIGH
Middle Name:NICHOLS
Last Name:COLBERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2559
Mailing Address - Country:US
Mailing Address - Phone:803-446-8606
Mailing Address - Fax:
Practice Address - Street 1:7451 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2602
Practice Address - Country:US
Practice Address - Phone:803-695-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist