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General NPI Number Information
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NPI Number | 1750404810
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Entity Type | Organization
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Legal Business Name | JAMES MONROE COLSTON
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 103 CLARKESVILLE ST
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City | CORNELIA
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State | GA
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Zip | 30531-3215
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Country | US
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Telephone | 706-778-2258
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Fax | 706-778-2259
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Provider Business Mailing Address
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Address Line | 103 CLARKESVILLE ST
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City | CORNELIA
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State | GA
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Zip | 30531-3215
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Country | US
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Telephone | 706-778-2258
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Fax | 706-778-2259
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Authorized Official
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Title or Position | OWNER
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Name | JAMES M. COLSTON
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Credential |
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Telephone | 706-778-2258
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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 | PHRE000153
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License Number State | GA
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