MEDICARE: COLOMBOS PHARMACY LLC

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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1669240214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLOMBOS PHARMACY LLC

Provider Business Mailing Address
First Line	:	7551 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2638
Country	:	US
Telephone Number	:	718-418-9700
Fax Number	:	718-418-7900

Provider Business Practice Location Address
First Line	:	7551 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2638
Country	:	US
Telephone Number	:	718-418-9700
Fax Number	:	718-418-7900

Authorized Official
Title or Position	:	RPH/OWNER
Name	:	MR. VITO ANTONINO COLOMBO
Credential	:
Telephone Number	:	718-418-9700

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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