Active NPI
Zackery Ray Colgrove, PHARMD
- Pharmacist
- Omaha, NE
National Provider Identifier
1063130680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17626
- Practice address
- 4405 N 72ND St
Omaha, NE 68134-2350 - Phone
- (402) 571-3122
- NPI assigned
- Aug 19, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17626 | NE | Primary |
Addresses
Primary practice location
4405 N 72ND St
Omaha, NE 68134-2350
Mailing address
601 S 31St Ave Apt 101
Omaha, NE 68105-1484
Phone (402) 594-3581
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17626 | NE | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dillon Companies LLC | Past | Accepting new patients | |
| Dillon Companies LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba King Soopers Pharmacy #153
- Community/Retail Pharmacy
- Fountain, CO
- NPI 1194524165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660867200000",
"number": "1063130680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 S 31ST AVE APT 101",
"city": "OMAHA",
"state": "NE",
"postal_code": "681051484",
"telephone_number": "402-594-3581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 N 72ND ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681342350",
"telephone_number": "402-571-3122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLGROVE",
"first_name": "ZACKERY",
"middle_name": "RAY",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-19",
"last_updated": "2022-08-19",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "17626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.