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General NPI Number Information
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NPI Number | 1649391194
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Entity Type | Organization
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Legal Business Name | COLONY DISCOUNT DRUGS INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 502 S GRANT ST
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City | FITZGERALD
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State | GA
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Zip | 31750-3312
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Country | US
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Telephone | 229-423-9801
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Fax | 229-423-9496
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Provider Business Mailing Address
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Address Line | 502 S GRANT ST
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City | FITZGERALD
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State | GA
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Zip | 31750-3312
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Country | US
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Telephone | 229-423-9801
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Fax | 229-423-9496
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Authorized Official
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Title or Position | PIC
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Name | SAMUEL LOKEY
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Credential |
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Telephone | 229-423-9801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE00437
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License Number State | GA
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