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General NPI Number Information
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NPI Number | 1619160702
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Entity Type | Organization
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Legal Business Name | COLONIA CARE PHARMACY
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 515 INMAN AVE STE A
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City | COLONIA
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State | NJ
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Zip | 07067-1114
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Country | US
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Telephone | 732-381-3400
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Fax | 732-381-7665
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Provider Business Mailing Address
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Address Line | 515 INMAN AVE STE A
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City | COLONIA
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State | NJ
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Zip | 07067-1114
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Country | US
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Telephone | 732-381-3400
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Fax | 732-381-7665
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Authorized Official
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Title or Position | OWNER
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Name | SVETISLAV MILIC
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Credential | R.PH.
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Telephone | 732-381-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 28RS00670500
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License Number State | NJ
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