Colosseum, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007587 Issued in MI

Legal business name

COLOSSEUM, INC.

Practice address

27260 Eureka Rd
Taylor, MI 48180-4845

Phone

(734) 955-9110

Fax

(734) 955-9101

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Raad Kouza, R PH

Title

Pharmacist

Phone

(734) 955-9110

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• ER DRUGS Doing business as

Locations

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1871674366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27260 EUREKA RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804845",
            "telephone_number": "734-955-9110",
            "fax_number": "734-955-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27260 EUREKA RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804845",
            "telephone_number": "734-955-9110",
            "fax_number": "734-955-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLOSSEUM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "KOUZA",
        "authorized_official_first_name": "RAAD",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "734-955-9110",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301007587",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4431348",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "540H221480",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ER DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Taylor, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; 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.