Provider Demographics
NPI:1134459787
Name:COLWELL, SHAWN H (RPH)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:H
Last Name:COLWELL
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 1:10860 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6694
Mailing Address - Country:US
Mailing Address - Phone:503-652-8058
Mailing Address - Fax:503-786-0316
Practice Address - Street 1:10860 SE OAK ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6694
Practice Address - Country:US
Practice Address - Phone:503-652-8058
Practice Address - Fax:503-786-0316
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist