Healthcare Provider Details

I. General information

NPI: 1114364494
Provider Name (Legal Business Name): JOSEPH C COLASANTE PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OGONTZ AVE
PHILADELPHIA PA
19138-1323
US

IV. Provider business mailing address

1317 BRONCO CIR
WARRINGTON PA
18976-1907
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-9997
  • Fax:
Mailing address:
  • Phone: 267-614-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: