Provider Demographics
NPI:1710576335
Name:BYNUM, COLTEN MARSHALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLTEN
Middle Name:MARSHALL
Last Name:BYNUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 DERBY RIDGE DR APT 308
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3492
Mailing Address - Country:US
Mailing Address - Phone:417-496-1216
Mailing Address - Fax:
Practice Address - Street 1:25 CONLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6477
Practice Address - Country:US
Practice Address - Phone:573-442-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200242661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist