MEDICARE: COLDAR

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	022865450-03	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176707	OTHER		PK

General Provider Information

NPI Number	:	1336645381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLDAR

Provider Business Mailing Address
First Line	:	PO BOX 3506
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43702-3506
Country	:	US
Telephone Number	:	740-452-7685
Fax Number	:	740-452-7665

Provider Business Practice Location Address
First Line	:	501 W MAIN ST
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-1029
Country	:	US
Telephone Number	:	740-452-7685
Fax Number	:	740-452-7655

Authorized Official
Title or Position	:	OWNER/MANAGER/AO
Name	:	JOHN COLER
Credential	:
Telephone Number	:	740-452-7685

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	07/27/2018

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Directions to “COLDAR ” Practice Location

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