NPIMap

Organization Active NPI

Colonial Drug Inc

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1801945605
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COLONIAL DRUG INC
Practice address
1727 N Vermont Ave Ste 107
Los Angeles, CA 90027-4343
Phone
(323) 666-4044
Fax
(323) 662-5674
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Suzanna Balyan, PHARM D
Title
President/Ceo
Phone
(323) 666-4044

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1727 N Vermont Ave Ste 107
Los Angeles, CA 90027-4343

Mailing address

1727 N Vermont Ave Ste 107
Los Angeles, CA 90027-4343
Phone (323) 666-4044

Other identifiers 1

IdentifierTypeStateIssuer
PHY58247OtherCABOARD OF PHARMACY

Other names 1

  • COLONIAL DRUG Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211119000229 CA DME Supplier - Pharmacy 4789073305 Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory
Tax ID family
Colonial Drug Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1801945605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 N VERMONT AVE STE 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900274343",
            "telephone_number": "323-666-4044",
            "fax_number": "323-662-5674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 N VERMONT AVE STE 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900274343",
            "telephone_number": "323-666-4044",
            "fax_number": "323-662-5674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "BALYAN",
        "authorized_official_first_name": "SUZANNA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "323-666-4044",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY58247",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLONIAL DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.