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General NPI Number Information
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NPI Number | 1619173556
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Entity Type | Organization
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Legal Business Name | COLOMA PHARMACY INC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 6577 PAW PAW AVE
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City | COLOMA
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State | MI
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Zip | 49038-8805
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Country | US
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Telephone | 269-468-6207
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Fax | 269-468-6707
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Provider Business Mailing Address
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Address Line | 6577 PAW PAW AVE
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City | COLOMA
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State | MI
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Zip | 49038-8805
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Country | US
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Telephone | 269-468-6207
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Fax | 269-468-6707
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Authorized Official
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Title or Position | OWNER
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Name | ASHABEN PATEL
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Credential |
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Telephone | 269-468-6207
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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 |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301008639
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008639
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License Number State | MI
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