Provider Demographics
NPI:1043210131
Name:CARLSON, COLLEEN M (PHARMD, CDM)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHARMD, CDM
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:GORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6501 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 51ST ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2831
Practice Address - Country:US
Practice Address - Phone:515-221-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist