Provider Demographics
NPI:1215169545
Name:COLWELL, ROBERT M (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:COLWELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3501 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1335
Mailing Address - Country:US
Mailing Address - Phone:505-255-8908
Mailing Address - Fax:505-255-5037
Practice Address - Street 1:3501 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1335
Practice Address - Country:US
Practice Address - Phone:505-255-8908
Practice Address - Fax:505-255-5037
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist