Provider Demographics
NPI:1962797431
Name:COLBY, JORY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JORY
Middle Name:
Last Name:COLBY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7017
Mailing Address - Country:US
Mailing Address - Phone:248-614-2801
Mailing Address - Fax:248-614-2801
Practice Address - Street 1:1301 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7017
Practice Address - Country:US
Practice Address - Phone:248-614-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist