Provider Demographics
NPI:1881133775
Name:KOLLER, NOLAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:
Last Name:KOLLER
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 1:2525 E 53RD AVE
Mailing Address - Street 2:APT A208
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-9133
Mailing Address - Country:US
Mailing Address - Phone:509-751-7874
Mailing Address - Fax:
Practice Address - Street 1:1000 N ARGONNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2600
Practice Address - Country:US
Practice Address - Phone:509-534-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 605474251835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care