Provider Demographics
NPI:1245840065
Name:PLOUZEK, COLTON JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:JOHN
Last Name:PLOUZEK
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 1:4848 W BEECHSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4917
Mailing Address - Country:US
Mailing Address - Phone:385-350-7563
Mailing Address - Fax:
Practice Address - Street 1:3403 W CHINDEN BLVD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7151
Practice Address - Country:US
Practice Address - Phone:986-200-4146
Practice Address - Fax:986-200-4137
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9001183500000X
UT7788409-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist