Provider Demographics
NPI:1629236591
Name:CREBS, COLIN KELLY (NUCLEAR PHARMACIST)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:KELLY
Last Name:CREBS
Suffix:
Gender:M
Credentials:NUCLEAR PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 CHIPETA WAY SUITE A
Mailing Address - Street 2:INTERMOUNTAIN RADIOPHARMACY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2703
Mailing Address - Country:US
Mailing Address - Phone:801-581-8189
Mailing Address - Fax:801-585-7273
Practice Address - Street 1:391 CHIPETA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1263
Practice Address - Country:US
Practice Address - Phone:801-581-8189
Practice Address - Fax:801-585-7273
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145579-17011835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear