Provider Demographics
NPI:1861543621
Name:COLCORD, DON ALLAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:ALLAN
Last Name:COLCORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAIN ST.
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:NUCLA
Mailing Address - State:CO
Mailing Address - Zip Code:81424-0429
Mailing Address - Country:US
Mailing Address - Phone:970-864-2100
Mailing Address - Fax:970-864-7926
Practice Address - Street 1:480 MAIN
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424-0429
Practice Address - Country:US
Practice Address - Phone:970-864-2100
Practice Address - Fax:970-864-7926
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03856101Medicaid
0609404OtherNABP
0609404OtherNABP