Provider Demographics
NPI:1093300865
Name:COLELL, EDMUND (CPHT)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:COLELL
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N JESSICA AVE APT 134
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2171
Mailing Address - Country:US
Mailing Address - Phone:520-256-6664
Mailing Address - Fax:
Practice Address - Street 1:615 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1900
Practice Address - Country:US
Practice Address - Phone:520-320-1184
Practice Address - Fax:520-320-3792
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT029988183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician