MEDICARE: THE COLONY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1821578063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COLONY PHARMACY LLC

Provider Business Mailing Address
First Line	:	1995 TIMBER RIDGE DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4690
Country	:	US
Telephone Number	:	214-680-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6053 MAIN ST STE 120
Second Line	:
City	:	THE COLONY
State	:	TX
Zip	:	75056-4706
Country	:	US
Telephone Number	:	214-680-0830
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. AKINDELE AKINSEYE
Credential	:
Telephone Number	:	214-680-0830

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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