Organization
COLONIAL PHARMACY INC
Active
Other names
COLONIAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BENNETT (PHARMACIST IN CHARGE)
(804) 746-7997
Entity
Organization
Contact information
Practice address
7510 MECHANICSVILLE TPKE, MECHANICSVILLE, VA 23111-2144
(804) 746-7997
(804) 746-5669
Mailing address
7510 MECHANICSVILLE TPKE, MECHANICSVILLE, VA 23111-2144
(804) 746-7997
(804) 746-5669
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201002983
VA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114096450
—
VA
01
—
4826371
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/08/2006
Last updated
12/10/2009
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