Organization
COLPHARM, INC.
Active
Other names
Colonial Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT EARLE BIRTH PD (PRESIDENT)
(570) 458-5573
Entity
Organization
Contact information
Practice address
5 MOUNTAIN MALL, SUITE 2, SHICKSHINNY, PA 18655-1227
(570) 542-2420
(570) 542-2396
Mailing address
PO BOX 477, 538 STATE STREET, MILLVILLE, PA 17846-0477
(570) 458-5573
(570) 458-6113
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP412844L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016460820001
—
PA
01
—
PP412488L
STATE PHARMACY LICENSE
PA
Enumeration date
11/20/2006
Last updated
08/22/2020
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