Active NPI
Colpharm, Inc.
Doing business as Colonial Pharmacy
- Community/Retail Pharmacy
- Shickshinny, PA
National Provider Identifier
1386718351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PP412844L
- Legal business name
- COLPHARM, INC.
- Doing business as
- Colonial Pharmacy
- Practice address
- 5 Mountain Mall
Suite 2
Shickshinny, PA 18655-1227 - Phone
- (570) 542-2420
- Fax
- (570) 542-2396
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Earle Birth, PD
- Title
- President
- Phone
- (570) 458-5573
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PP412844L | PA | Primary |
Addresses
Primary practice location
5 Mountain Mall
Suite 2
Shickshinny, PA 18655-1227
Mailing address
PO Box 477
538 State Street
Millville, PA 17846-0477
Phone (570) 458-5573
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PP412488L | Other | PA | STATE PHARMACY LICENSE |
| 1016460820001 | Medicaid | PA |
Other names 1
- Colonial Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Colonial Pharmacy
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
Locations
5 Mountain Mall
Ste 2
Shickshinny, PA 18655
Phone (570) 542-2420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1386718351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 477",
"address_2": "538 STATE STREET",
"city": "MILLVILLE",
"state": "PA",
"postal_code": "178460477",
"telephone_number": "570-458-5573",
"fax_number": "570-458-6113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 MOUNTAIN MALL",
"address_2": "SUITE 2",
"city": "SHICKSHINNY",
"state": "PA",
"postal_code": "186551227",
"telephone_number": "570-542-2420",
"fax_number": "570-542-2396"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COLPHARM, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BIRTH",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "EARLE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "570-458-5573",
"authorized_official_credential": "PD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "PA",
"license": "PP412844L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PHARMACY LICENSE",
"identifier": "PP412488L",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1016460820001",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Colonial Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shickshinny, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.