Provider Demographics
NPI:1063823920
Name:COLBY, DANIEL MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARK
Last Name:COLBY
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 1:915 RED FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-8884
Mailing Address - Country:US
Mailing Address - Phone:775-303-6536
Mailing Address - Fax:
Practice Address - Street 1:11230 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4808
Practice Address - Country:US
Practice Address - Phone:530-587-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16184183500000X
CA43639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist