COLLEEN KOM (NPI# 1407480809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407480809 |
| Entity Type | Individual |
| Full Name | COLLEEN KOM |
| Practice Address |
900 E Main St Waterford WI 53185-4536 |
| Mailing Address |
W230s8995 Clark St Big Bend WI 53103-9479 |
| Practice Telephone | 2625144290 |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-02-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 19135-40 | WI | Pharmacy Service Providers |
| Street Address |
900 E MAIN ST |
| City | WATERFORD |
| State | WI |
| Zip Code | 53185-4536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164044491 | Pavneet Kaur Dhillon | Pharmacist | 900 E Main St, Waterford, WI 53185-4536 | 2020-05-08 |
| 1285267872 | Spencer Polacek | Pharmacist | 900 E Main St, Waterford, WI 53185-4536 | 2020-02-21 |
| 1962810259 | Jonathan Lancourt | Pharmacist | 900 E Main St, Waterford, WI 53185-4536 | 2014-07-30 |
| 1184908287 | Jennifer Lucas | Pharmacist | 900 E Main St, Waterford, WI 53185-4536 | 2011-10-06 |
| 1528342797 | Kimberly Ruona | Pharmacist | 900 E Main St, Waterford, WI 53185-4536 | 2011-10-05 |
| 1639471352 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 900 E Main St, Waterford, WI 53185-4536 | 2010-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649755695 | Alyssa Jane Revolinski | Respite Care | 269435 S Elm Lane, Waterford, WI 53185 | 2018-09-26 |
| 1871973370 | Julie Minikowski | Community Health Worker | 207 Milwaukee Avenue, A, Waterford, WI 53185 | 2015-06-01 |
| 1629235031 | Fluegge Optical | Technician/Technologist | 920 E Main Street, Waterford, WI 53185 | 2008-05-22 |
| 1659598209 | Julie Michals | Occupational Therapist | 1701 Sharp Road, Waterford, WI 53185 | 2007-04-18 |
| 1518072768 | Jennifer Jayne Decker | Family Medicine | 818 Forrest Ln, Waterford, WI 53185 | 2006-08-20 |
| 1215966908 | Amy Beth Flock | Physical Therapy Assistant | 2319 Fox Knoll Dr, Waterford, WI 53185 | 2006-07-03 |
| 1750762472 | Tesalia R Renteria | Family Medicine | 818 Forest Ln, Waterford, WI 53185 | 2015-06-18 |
| 1649651092 | Kathryn C Halyko | Pediatrics | 818 Forest Ln, Waterford, WI 53185 | 2015-06-11 |
| 1518109735 | Daniel A Allison | Family Medicine | 818 Forest Ln, Waterford, WI 53185 | 2009-04-02 |
| 1811178478 | Daniel Mark Gifford | Speech-Language Pathologist | 1701 Sharp Rd, Lakeview Specialty Hospital, Waterford, WI 53185 | 2007-11-23 |
| Find all providers in zip 53185 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437631850 | Rana Ismail | Pharmacist | 3273 West Huron St, Waterford, MI 48328 | 2018-09-01 |
| 1982115697 | Neil Mehta | Pharmacist | 4000 Highland Rd Ste 113, Waterford, MI 48328-2163 | 2017-10-20 |
| 1306363957 | David Powell | Pharmacist | 279 Summit Dr # 200, Waterford, MI 48328-3364 | 2017-08-24 |
| 1750765798 | Shatha Matti | Pharmacist | 7362 Highland Road, Waterford, MI 48327 | 2015-07-18 |
| 1871905646 | Howard Kramer | Pharmacist | 7840 Academy Ct E, Waterford, MI 48329-4631 | 2014-05-28 |
| 1780942086 | Danielle M Baldwin | Pharmacist | 37 Clifton St, Waterford, NY 12188-2625 | 2012-04-25 |
| 1013285089 | Neil L Bluestone | Pharmacist | 4400 Highland Rd # M-59, Waterford, MI 48328-1222 | 2011-12-06 |
| 1700160660 | Warren B Rogers Jr. | Pharmacist | 303 Millstone Rd East, Waterford, CT 06385-3225 | 2011-10-10 |
| 1821372400 | John Carfi | Pharmacist | 5 Whaling Dr, Waterford, CT 06385-3319 | 2011-09-30 |
| 1265715635 | Jatin Patel | Pharmacist | 4400 Highland Road, Waterford, MICHIGAN 48328 | 2011-09-22 |
| Find all providers in WATERFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.