Provider Demographics
NPI:1669044558
Name:HUSSEY, COLETTE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:MARIE
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3978
Mailing Address - Country:US
Mailing Address - Phone:515-279-3074
Mailing Address - Fax:515-279-3128
Practice Address - Street 1:3030 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3978
Practice Address - Country:US
Practice Address - Phone:515-279-3074
Practice Address - Fax:515-279-3128
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty