Provider Demographics
NPI:1104253228
Name:HOWARD, COLLEEN NELLIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:NELLIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2884
Mailing Address - Country:US
Mailing Address - Phone:231-347-7281
Mailing Address - Fax:
Practice Address - Street 1:1401 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2884
Practice Address - Country:US
Practice Address - Phone:231-347-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist