Provider Demographics
NPI:1053428193
Name:COLONIAL PHARMACY, INC.
Entity type:Organization
Organization Name:COLONIAL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KEREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-3569
Mailing Address - Street 1:1915 N CLEVELAND-MASSILLON RD
Mailing Address - Street 2:P O BOX 396
Mailing Address - City:BATH
Mailing Address - State:OH
Mailing Address - Zip Code:44210-0396
Mailing Address - Country:US
Mailing Address - Phone:330-666-3569
Mailing Address - Fax:
Practice Address - Street 1:1915 N CLEVELAND-MASSILLON RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:OH
Practice Address - Zip Code:44210-0396
Practice Address - Country:US
Practice Address - Phone:330-666-3569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy