Colbert Pharmacy Inc 127 4TH St

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE004838 Issued in GA

Legal business name

COLBERT PHARMACY INC 127 4TH ST

Doing business as

Colbert Pharmacy

Practice address

5674 Highway 72 W
Colbert, GA 30628-2934

Phone

(706) 788-2102

Fax

(706) 788-9740

NPI assigned

Nov 17, 2006

Last updated

Jun 7, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Walter White, RPH

Title

Pres

Phone

(706) 788-2102

Specialties & licenses 2

Addresses

Other names 1

• COLBERT PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1164596680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 336",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280336",
            "telephone_number": "706-788-2102",
            "fax_number": "706-788-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5674 HIGHWAY 72 W",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306282934",
            "telephone_number": "706-788-2102",
            "fax_number": "706-788-9740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLBERT PHARMACY INC 127 4TH ST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "706-788-2102",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE004838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLBERT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nora Ann Blankenship, LCSW
• Blue Lakes Care LLC
• Vandana Chakravarthy Centa, D.O
• Karla Coco
• Robyn Cain Crouse, PT
• Matthew Davis, M.D.
• Nicole Ford, NP-C
• Jimmie Lee Fowler III, RN
• Manuel Garcia-Gaona, PT, DPT

• Community/Retail Pharmacy in Colbert, GA
• Providers in Colbert, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.