Provider Demographics
NPI:1902159700
Name:STAHELI, COLONEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLONEL
Middle Name:
Last Name:STAHELI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 OXFORD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8585
Mailing Address - Country:US
Mailing Address - Phone:435-669-9421
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE CENTRE DR STE 400
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2663
Practice Address - Country:US
Practice Address - Phone:800-947-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6989777-1701183500000X
TN45923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist