Active NPI
Ethan Garret Colwell
- Pharmacist
- Wagoner, OK
National Provider Identifier
1114408010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18071
- Practice address
- 1305 W Cherokee St
Wagoner, OK 74467-4625 - Phone
- (918) 485-6688
- NPI assigned
- Aug 28, 2018
- Last updated
- Aug 28, 2018
- 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 | 18071 | OK | Primary |
Addresses
Primary practice location
1305 W Cherokee St
Wagoner, OK 74467-4625
Mailing address
6681 N 431
Pryor, OK 74361-2395
Phone (918) 373-4626
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18071 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TMC Pharmacy Inc | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535414400000",
"number": "1114408010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6681 N 431",
"city": "PRYOR",
"state": "OK",
"postal_code": "743612395",
"telephone_number": "918-373-4626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 W CHEROKEE ST",
"city": "WAGONER",
"state": "OK",
"postal_code": "744674625",
"telephone_number": "918-485-6688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLWELL",
"first_name": "ETHAN",
"middle_name": "GARRET",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-28",
"last_updated": "2018-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "18071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wagoner, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.