Provider Demographics
NPI:1215535430
Name:DOUGHERTY, COLLEEN THERESE (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:THERESE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 E POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3016
Mailing Address - Country:US
Mailing Address - Phone:651-458-7002
Mailing Address - Fax:
Practice Address - Street 1:7280 E POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3016
Practice Address - Country:US
Practice Address - Phone:651-458-7002
Practice Address - Fax:651-458-4110
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy