Colin Edenholm, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHA-PHA-LIC-58476 Issued in MT

Practice address

2611 Harrison Ave
Butte, MT 59701-3759

Phone

(406) 782-5471

Fax

(406) 782-5361

NPI assigned

Sep 21, 2019

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rxm.13818@store.walgreens.com

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.

• Walgreen Co

  dba Walgreens #13818

  • Pharmacy
  • Butte, MT
  • NPI 1487925459
  NPD
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1770134744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 HARRISON AVE",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597013759",
            "telephone_number": "406-782-5471",
            "fax_number": "406-782-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 HARRISON AVE",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597013759",
            "telephone_number": "406-782-5471",
            "fax_number": "406-782-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDENHOLM",
        "first_name": "COLIN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-21",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "PHA-PHA-LIC-58476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rxm.13818@store.walgreens.com",
            "affiliation": "Y",
            "affiliationName": "WALGREEN CO",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2611 Harrison Ave",
            "city": "Butte",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597013759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pharmacist in Butte, MT
• Providers in Butte, MT by specialty
• Pharmacist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.