Provider Demographics
NPI:1962126631
Name:COLMER, JONATHAN ASHLEY (RPH)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ASHLEY
Last Name:COLMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NORTHSHORE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8658
Mailing Address - Country:US
Mailing Address - Phone:601-506-6339
Mailing Address - Fax:
Practice Address - Street 1:3201 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3502
Practice Address - Country:US
Practice Address - Phone:601-939-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist