Organization
COLBERT PHARMACY INC 127 4TH ST
Active
Other names
COLBERT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER WHITE RPH (PRES)
(706) 788-2102
Entity
Organization
Contact information
Practice address
5674 HIGHWAY 72 W, COLBERT, GA 30628-2934
(706) 788-2102
(706) 788-9740
Mailing address
PO BOX 336, COLBERT, GA 30628-0336
(706) 788-2102
(706) 788-9470
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE004838
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00025165A
—
GA
01
—
1102425
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/17/2006
Last updated
06/07/2011
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