MEDICARE: COLONIAL DRUG INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY58247	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1801945605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL DRUG INC

Provider Business Mailing Address
First Line	:	1727 N VERMONT AVE STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4343
Country	:	US
Telephone Number	:	323-666-4044
Fax Number	:	323-662-5674

Provider Business Practice Location Address
First Line	:	1727 N VERMONT AVE STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4343
Country	:	US
Telephone Number	:	323-666-4044
Fax Number	:	323-662-5674

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	SUZANNA BALYAN
Credential	:	PHARM D
Telephone Number	:	323-666-4044

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/21/2021

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Directions to “COLONIAL DRUG INC ” Practice Location

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