MEDICARE: FIRST COLONY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	0313	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3001043	OTHER	NH	NAPB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043380470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COLONY CORP

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	NEW LONDON
State	:	NH
Zip	:	03257-0010
Country	:	US
Telephone Number	:	603-526-2233
Fax Number	:	603-526-2235

Provider Business Practice Location Address
First Line	:	82 NEWPORT RD
Second Line	:
City	:	NEW LONDON
State	:	NH
Zip	:	03257-5414
Country	:	US
Telephone Number	:	603-526-2233
Fax Number	:	603-526-2235

Authorized Official
Title or Position	:	VP
Name	:	GLENN PERREAULT
Credential	:
Telephone Number	:	603-526-2233

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	12/23/2021

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Directions to “FIRST COLONY CORP ” Practice Location

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