Provider Demographics
NPI:1881257327
Name:GUTHRO, NICOLEENA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:NICOLEENA
Middle Name:MARIE
Last Name:GUTHRO
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 1:2881 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-5064
Mailing Address - Country:US
Mailing Address - Phone:970-241-6652
Mailing Address - Fax:970-255-8054
Practice Address - Street 1:2881 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5064
Practice Address - Country:US
Practice Address - Phone:970-241-6652
Practice Address - Fax:970-255-8054
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist