Provider Demographics
NPI:1528419447
Name:COULSON, TROY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:COULSON
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 1:2100 ALAN ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5801
Mailing Address - Country:US
Mailing Address - Phone:208-470-7979
Mailing Address - Fax:888-626-5817
Practice Address - Street 1:2100 ALAN ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5801
Practice Address - Country:US
Practice Address - Phone:208-470-7979
Practice Address - Fax:888-626-5817
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-62955183500000X
UT9763995-1701183500000X
IDP7519183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy