Provider Demographics
NPI:1043538101
Name:COLOMB, FELIX
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:
Last Name:COLOMB
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 1:5214-30 BALTIMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3240
Mailing Address - Country:US
Mailing Address - Phone:215-476-1724
Mailing Address - Fax:215-474-8354
Practice Address - Street 1:5214 - 30 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3240
Practice Address - Country:US
Practice Address - Phone:215-476-1724
Practice Address - Fax:215-474-8354
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist