Provider Demographics
NPI:1306874656
Name:COLLEY, COLLEEN ANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:COLLEY
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 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-402-2919
Practice Address - Street 1:P-5-PHARM/COAG VA MEDICAL CENTER
Practice Address - Street 2:3710 SW US VETERANS HOSPITAL ROAD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201
Practice Address - Country:US
Practice Address - Phone:503-402-2946
Practice Address - Fax:503-402-2919
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist