# COLONIAL CLINICAL SERVICES LLC

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

## Provider details

- **NPI number:** 1336711647
- **Authorized official:** GLENN PERREAULT PHARMD (OWNER/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (603) 526-2233

## Contact information

- **Practice address:** 82 NEWPORT RD, NEW LONDON, NH 03257-5414
- **Practice address phone:** (603) 526-2233
- **Practice address fax:** (603) 526-2235
- **Mailing address:** PO BOX 10, NEW LONDON, NH 03257-0010
- **Mailing address phone:** (603) 526-2233
- **Mailing address fax:** (603) 526-2235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2021
- **Last updated:** 07/15/2021