Ethan Garret Colwell

NPI #1114408010 in Wagoner, Oklahoma

Provider Information

NPI Number: 1114408010
Entity Type: Individual
Name: Ethan Garret Colwell
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Aug 28, 2018
Last Updated: Aug 28, 2018

Practice Location

Address: 1305 W CHEROKEE ST
City: Wagoner
State: Oklahoma
ZIP Code: 74467-4625
Phone: (918) 485-6688

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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