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General NPI Number Information
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NPI Number | 1770941825
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Entity Type | Organization
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Legal Business Name | COLORECTAL PHARMACY INC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 2500 HOSPITAL BLVD SUITE 150-A
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City | ROSWELL
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State | GA
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Zip | 30076-4907
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Country | US
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Telephone | 678-935-0331
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Fax | 678-935-0353
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Provider Business Mailing Address
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Address Line | 2500 HOSPITAL BLVD SUITE 150-A
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City | ROSWELL
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State | GA
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Zip | 30076-4907
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Country | US
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Telephone | 678-935-0331
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Fax | 678-935-0353
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SCOTT GOLDMAN
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Credential |
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Telephone | 678-935-0331
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHRE010265
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License Number State | GA
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