Provider Demographics
NPI:1720533607
Name:COLWELL, SARAH ELLANA (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELLANA
Last Name:COLWELL
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 N PRICE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-2747
Mailing Address - Country:US
Mailing Address - Phone:520-220-8962
Mailing Address - Fax:
Practice Address - Street 1:2619 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6722
Practice Address - Country:US
Practice Address - Phone:208-706-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist