# COLORECTAL PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CRC Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770941825
- **Authorized official:** SCOTT GOLDMAN (VICE PRESIDENT)
- **Authorized official phone:** (678) 935-0331

## Contact information

- **Practice address:** 2500 HOSPITAL BLVD, SUITE 150-A, ROSWELL, GA 30076-4907
- **Practice address phone:** (678) 935-0331
- **Practice address fax:** (678) 935-0353
- **Mailing address:** 2500 HOSPITAL BLVD, SUITE 150-A, ROSWELL, GA 30076-4907
- **Mailing address phone:** (678) 935-0331
- **Mailing address fax:** (678) 935-0353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | — | — |
| 3336C0004X | Compounding Pharmacy | PHRE010265 | GA | Yes |

## Other

- **Enumeration date:** 02/03/2016
- **Last updated:** 02/05/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2157931 | PK | — |