Provider Demographics
NPI:1598292922
Name:MCCOLL, IAN THOMAS (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:THOMAS
Last Name:MCCOLL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3432
Mailing Address - Country:US
Mailing Address - Phone:860-561-6164
Mailing Address - Fax:860-561-8546
Practice Address - Street 1:150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3432
Practice Address - Country:US
Practice Address - Phone:860-561-6164
Practice Address - Fax:860-561-8546
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0011990OtherCT DEPARTMET OF CONSUMER PROTECTION