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General NPI Number Information
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NPI Number | 1871623975
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Entity Type | Organization
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Legal Business Name | COLONY PRESCRIPTION SHOP
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 1230 E MCPHERSON ST
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City | NASHVILLE
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State | GA
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Zip | 31639-2369
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Country | US
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Telephone | 229-686-2088
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Fax | 229-686-2088
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Provider Business Mailing Address
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Address Line | 1230 E MCPHERSON ST
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City | NASHVILLE
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State | GA
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Zip | 31639-2369
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Country | US
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Telephone | 229-686-2088
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Fax | 229-686-2088
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. DANIEL W RUSS
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Credential | RPH
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Telephone | 229-686-2088
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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 | PHRE005581
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License Number State | GA
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