Provider Demographics
NPI:1750863783
Name:MCCARREN, COLEEN A
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:A
Last Name:MCCARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1821
Mailing Address - Country:US
Mailing Address - Phone:215-561-1316
Mailing Address - Fax:
Practice Address - Street 1:1617 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1821
Practice Address - Country:US
Practice Address - Phone:215-561-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist