Provider Demographics
NPI:1538767033
Name:FUDE, COLTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:
Last Name:FUDE
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 1:15205 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1519
Mailing Address - Country:US
Mailing Address - Phone:262-796-2734
Mailing Address - Fax:
Practice Address - Street 1:2727 S 130TH ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4033
Practice Address - Country:US
Practice Address - Phone:920-960-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist