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Organization
COLORECTAL PHARMACY INC
Active
Organization
COLORECTAL PHARMACY INC
Active
Other names
CRC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT GOLDMAN (VICE PRESIDENT)
(678) 935-0331
Entity
Organization
Contact information
Practice address
2500 HOSPITAL BLVD, SUITE 150-A, ROSWELL, GA 30076-4907
(678) 935-0331
(678) 935-0353
Mailing address
2500 HOSPITAL BLVD, SUITE 150-A, ROSWELL, GA 30076-4907
(678) 935-0331
(678) 935-0353
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHRE010265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157931
PK
—
Enumeration date
02/03/2016
Last updated
02/05/2016
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