Provider Demographics
NPI:1669849865
Name:MARTIN, COLLEEN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:L
Last Name:MARTIN
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 1:3401 S BROADWAY UNIT 180
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2526
Mailing Address - Country:US
Mailing Address - Phone:720-405-5125
Mailing Address - Fax:720-405-5126
Practice Address - Street 1:3401 S BROADWAY UNIT 180
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2526
Practice Address - Country:US
Practice Address - Phone:720-405-5125
Practice Address - Fax:720-405-5126
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO202-0014OtherAPHA IMMUNIZATION CERTIFICATION