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General NPI Number Information
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NPI Number | 1386718351
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Entity Type | Organization
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Legal Business Name | COLPHARM, INC.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5 MOUNTAIN MALL SUITE 2
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City | SHICKSHINNY
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State | PA
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Zip | 18655-1227
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Country | US
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Telephone | 570-542-2420
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Fax | 570-542-2396
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Provider Business Mailing Address
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Address Line | PO BOX 477 538 STATE STREET
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City | MILLVILLE
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State | PA
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Zip | 17846-0477
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Country | US
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Telephone | 570-458-5573
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Fax | 570-458-6113
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT EARLE BIRTH
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Credential | PD
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Telephone | 570-458-5573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP412844L
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License Number State | PA
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