Provider Demographics
NPI:1316583743
Name:COLWELL, ROXANNE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:LYNN
Last Name:COLWELL
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 1:1300 SERENA LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-7124
Mailing Address - Country:US
Mailing Address - Phone:262-813-9028
Mailing Address - Fax:
Practice Address - Street 1:601 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4405
Practice Address - Country:US
Practice Address - Phone:262-534-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40-18628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist