Provider Demographics
NPI:1588997399
Name:NELSON, SELENA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SELENA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SELENA
Other - Middle Name:MARIE
Other - Last Name:LANOUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1103 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5664
Mailing Address - Country:US
Mailing Address - Phone:970-221-3073
Mailing Address - Fax:970-221-5782
Practice Address - Street 1:1103 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5664
Practice Address - Country:US
Practice Address - Phone:970-221-3073
Practice Address - Fax:970-221-5782
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist