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General NPI Number Information
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NPI Number | 1871674366
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Entity Type | Organization
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Legal Business Name | COLOSSEUM, INC.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 27260 EUREKA RD
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City | TAYLOR
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State | MI
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Zip | 48180-4845
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Country | US
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Telephone | 734-955-9110
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Fax | 734-955-9101
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Provider Business Mailing Address
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Address Line | 27260 EUREKA RD
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City | TAYLOR
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State | MI
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Zip | 48180-4845
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Country | US
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Telephone | 734-955-9110
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Fax | 734-955-9101
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. RAAD KOUZA
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Credential | R PH
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Telephone | 734-955-9110
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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 | 5301007587
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License Number State | MI
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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 | 5301007587
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License Number State | MI
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