Provider Demographics
NPI:1811489800
Name:LAIRD, COLIN
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:LAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16659-9626
Mailing Address - Country:US
Mailing Address - Phone:814-766-3208
Mailing Address - Fax:
Practice Address - Street 1:3432 ROUTE 764 SUGAR RUN PLAZA
Practice Address - Street 2:CARDINAL HEALTH
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-942-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043982L1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear