Provider Demographics
NPI:1508266180
Name:COLGAN, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:COLGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5232
Mailing Address - Country:US
Mailing Address - Phone:860-885-8667
Mailing Address - Fax:
Practice Address - Street 1:3011 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1164
Practice Address - Country:US
Practice Address - Phone:575-647-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82074183500000X
NM9921183500000X
SC35740183500000X
CT11980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82074OtherCA PHARMACIST LICENSE
NM9921OtherNM PHARMACIST LICENSE
TX72915OtherTX PHARMACIST LICENSE
SC35740OtherSC LICENSE PHARMACY