Provider Demographics
NPI:1124160049
Name:COLEGROVE, COLLEEN M (RPH)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:COLEGROVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:19137 NUNIVAK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8660
Mailing Address - Country:US
Mailing Address - Phone:706-768-5689
Mailing Address - Fax:
Practice Address - Street 1:2550 E 88TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3814
Practice Address - Country:US
Practice Address - Phone:907-349-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017478183500000X
AK168417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist