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

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

Other identifiers 1

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

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

  • 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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WALGREENS",
            "identifier": "43231315",
            "state": null
        }
    ],
    "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": []
}

• Kylee Duncan
• Wendy Dyer
• Eaglemed LLC
• Eastern Plains-Clinic of Urology, LLC
• Sherrie Eaves, PMHNP-BC
• Amber Rae Edwards, FNP-C, APRN
• Questa M Edwards, OTR/L
• Allison Katherine Eisenzimer, PHARMD
• Stephanie Eissinger, LCPC
• Marylucy Elema, DMD

• All providers in Butte, MT
• 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.