# COLONY PRESCRIPTION SHOP

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

## Provider details

- **NPI number:** 1871623975
- **Authorized official:** MR. DANIEL W RUSS RPH (PHARMACIST IN CHARGE)
- **Authorized official phone:** (229) 686-2088

## Contact information

- **Practice address:** 1230 E MCPHERSON ST, NASHVILLE, GA 31639-2369
- **Practice address phone:** (229) 686-2088
- **Practice address fax:** (229) 686-2088
- **Mailing address:** 1230 E MCPHERSON ST, NASHVILLE, GA 31639-2369
- **Mailing address phone:** (229) 686-2088
- **Mailing address fax:** (229) 686-2088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE005581 | GA | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 06/04/2008