Colbert Pharmacy Inc 127 4TH St
Organization Active NPI Community/Retail Pharmacy · Colbert, GA
NPI 1164596680 · NPPES record last updated Jun 7, 2011
Key facts
- NPI
- 1164596680
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE004838 (GA)
- Legal business name
- COLBERT PHARMACY INC 127 4TH ST
- Practice address
- 5674 Highway 72 W
Colbert, GA 30628-2934 - Phone
- (706) 788-2102
- Fax
- (706) 788-9740
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Walter White, RPH
- Title
- Pres
- Phone
- (706) 788-2102
National Provider Directory
Locations
5674 Highway 72 W
Colbert, GA 30628
Phone (706) 788-2102
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHRE004838 | GA | Yes |
Addresses
Primary practice location
5674 Highway 72 W
Colbert, GA 30628-2934
Mailing address
PO Box 336
Colbert, GA 30628-0336
Phone (706) 788-2102
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1102425 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| 00025165A | Medicaid | GA |
Other names
- COLBERT PHARMACY
Other providers in Colbert, GA
- Nora Ann Blankenship
- Blue Lakes Care LLC
- Vandana Chakravarthy Centa
- Karla Coco
- Robyn Cain Crouse
- Matthew Davis
- Nicole Ford
- Jimmie Lee Fowler III
- Manuel Garcia-Gaona
All providers in Colbert, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.