Organization
COLONIAL PHARMACY OF WHITESBORO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BRAYTON LANGDON III RPH (PRESIDENT SUPERVISING PHARMACIST)
(315) 736-2122
Entity
Organization
Contact information
Practice address
100 MAIN ST, WHITESBORO, NY 13492-1027
(315) 736-2122
(315) 736-7376
Mailing address
100 MAIN ST, WHITESBORO, NY 13492-1027
(315) 736-2122
(315) 736-7376
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
025256
NY
3336C0003X
Community/Retail Pharmacy
Primary
025256
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02228999
—
NY
01
—
3324681
NCPDP
—
Enumeration date
08/25/2006
Last updated
03/07/2023
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