Colony Prescription Shop

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE005581 Issued in GA

Legal business name

COLONY PRESCRIPTION SHOP

Practice address

1230 E McPherson St
Nashville, GA 31639-2369

Phone

(229) 686-2088

Fax

(229) 686-2088

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Daniel W Russ, RPH

Title

Pharmacist in Charge

Phone

(229) 686-2088

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212537600000",
    "number": "1871623975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MCPHERSON ST",
            "city": "NASHVILLE",
            "state": "GA",
            "postal_code": "316392369",
            "telephone_number": "229-686-2088",
            "fax_number": "229-686-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MCPHERSON ST",
            "city": "NASHVILLE",
            "state": "GA",
            "postal_code": "316392369",
            "telephone_number": "229-686-2088",
            "fax_number": "229-686-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONY PRESCRIPTION SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-06-04",
        "status": "A",
        "authorized_official_last_name": "RUSS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "229-686-2088",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE005581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000025242A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BNC Medical Investors LLC
• Rebecca Elaine Boatner, FNP
• Christi L Budd, M.ED., CCC-SLP
• William Anthony Bush, DPT
• Cassia Capers, M.S, LMFT
• Jeffery N. Cox, D.M.D.
• Abhinav Dasyam
• Henry J. Decker, O.D.
• William Greg Dent, PHARMD
• Direct Doc, LLC

• All providers in Nashville, GA
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; 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.