# COLONIAL LTC PHARMACY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275838492
- **Authorized official:** MR. ROBERT BRAYTON LANGDON III RPH. (PRESIDENT)
- **Authorized official phone:** (315) 868-4073

## Contact information

- **Practice address:** 100 MAIN ST, SUITE 1, WHITESBORO, NY 13492-1027
- **Practice address phone:** (315) 868-4073
- **Practice address fax:** (315) 736-7396
- **Mailing address:** 100 MAIN ST, SUITE 1, WHITESBORO, NY 13492-1027
- **Mailing address phone:** (315) 868-4073
- **Mailing address fax:** (315) 736-7396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 030513 | NY | Yes |

## Other

- **Enumeration date:** 01/19/2011
- **Last updated:** 01/19/2011