Provider Demographics
NPI:1629378229
Name:CALLAHAN, TED (RPH)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 G ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2019
Mailing Address - Country:US
Mailing Address - Phone:719-539-6933
Mailing Address - Fax:719-539-1538
Practice Address - Street 1:232 G ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2019
Practice Address - Country:US
Practice Address - Phone:719-539-6933
Practice Address - Fax:719-539-1538
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist