Provider Demographics
NPI:1609401033
Name:COLOMBE, MARGARET (RPH)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:COLOMBE
Suffix:
Gender:F
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:W283N3352 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3332
Mailing Address - Country:US
Mailing Address - Phone:414-704-3457
Mailing Address - Fax:
Practice Address - Street 1:1130 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8422
Practice Address - Country:US
Practice Address - Phone:262-446-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10013-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist