Organization
COLONIAL PHARMACY INC
Active
Other names
COLONIAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BURSTYN (PRESIDENT/PIC)
(626) 447-3591
Entity
Organization
Contact information
Practice address
1326 S BALDWIN AVE, ARCADIA, CA 91007-7512
(626) 447-3591
(626) 447-4679
Mailing address
1326 S BALDWIN AVE, ARCADIA, CA 91007-7512
(626) 447-3591
(626) 447-4679
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
44156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5636456
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA441560
—
CA
Enumeration date
01/16/2008
Last updated
06/09/2010
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