Healthcare Provider Details

I. General information

NPI: 1235724675
Provider Name (Legal Business Name): COLER DRUG LOUDONVILLE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MAIN ST
LOUDONVILLE OH
44842-1134
US

IV. Provider business mailing address

PO BOX 3506
ZANESVILLE OH
43702-3506
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-3221
  • Fax:
Mailing address:
  • Phone: 740-452-7685
  • Fax: 740-452-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC BLAKE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 740-452-7685