Provider Demographics
NPI:1962815365
Name:COLVIN, KYM D (RPH)
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:D
Last Name:COLVIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 DESERADO DR
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-4401
Mailing Address - Country:US
Mailing Address - Phone:303-514-7186
Mailing Address - Fax:
Practice Address - Street 1:2460 GOLDEN EDGE DRIVE
Practice Address - Street 2:
Practice Address - City:KREMMLING
Practice Address - State:CO
Practice Address - Zip Code:80458
Practice Address - Country:US
Practice Address - Phone:970-724-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114871835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy