Colley Discount Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201002209 Issued in VA

Legal business name

COLLEY DISCOUNT PHARMACY INC

Practice address

1415 Colley Ave
Norfolk, VA 23517-1705

Phone

(757) 622-2757

Fax

(757) 640-0367

NPI assigned

Jul 30, 2006

Organization subpart

No

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

Authorized official

Name

Stephan Buchberg

Title

Owner

Phone

(757) 622-2757

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• COLLEY DISCOUNT PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1619982212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 COLLEY AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171705",
            "telephone_number": "757-622-2757",
            "fax_number": "757-640-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 COLLEY AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171705",
            "telephone_number": "757-622-2757",
            "fax_number": "757-640-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEY DISCOUNT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "BUCHBERG",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-622-2757"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201002209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008510059",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2102952",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLLEY DISCOUNT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Whitney L Coleman, RRT
• Lawrence B Colen, M.D.
• Marilou Colgan, RD
• Elfren Colinco Jr., R.N.
• Collaborative Health Outreach of Virginia
• Aldon Rockwell Collier, M.D.
• Samantha Collins-Hudson, RRT
• Channa Stefanee Collins, PA-C
• Jamie Collins
• Jimmie Nelson Collins, MD

• Community/Retail Pharmacy in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.