Provider Demographics
NPI:1942833058
Name:COLEGROVE, DAVID RUSSELL (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:COLEGROVE
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 1:8163 MILLWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7394
Mailing Address - Country:US
Mailing Address - Phone:614-371-4522
Mailing Address - Fax:
Practice Address - Street 1:8163 MILLWAY LOOP
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7394
Practice Address - Country:US
Practice Address - Phone:614-371-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist