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General NPI Number Information
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NPI Number | 1518286368
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Entity Type | Organization
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Legal Business Name | COLUMBIA PHARMACY, INC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 214 MAIN STREET
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City | COLUMBIA
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State | NC
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Zip | 27925
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Country | US
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Telephone | 252-796-2421
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Fax | 252-796-1124
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | COLUMBIA
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State | NC
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Zip | 27925-0239
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Country | US
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Telephone | 252-796-2421
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Fax | 252-796-1124
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Authorized Official
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Title or Position | PHARMACIST/MANAGER/OWNER
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Name | MR. JOHN DANA OUTTEN
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Credential | RPH
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Telephone | 252-796-2421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 09900
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License Number State | NC
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