Provider Demographics
NPI:1770935603
Name:COLBY, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:COLBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2291
Mailing Address - Country:US
Mailing Address - Phone:517-627-2800
Mailing Address - Fax:
Practice Address - Street 1:715 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2291
Practice Address - Country:US
Practice Address - Phone:517-627-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist