Organization
COLLEY DISCOUNT PHARMACY INC
Active
Other names
COLLEY DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN BUCHBERG (OWNER)
(757) 622-2757
Entity
Organization
Contact information
Practice address
1415 COLLEY AVE, NORFOLK, VA 23517-1705
(757) 622-2757
(757) 640-0367
Mailing address
1415 COLLEY AVE, NORFOLK, VA 23517-1705
(757) 622-2757
(757) 640-0367
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201002209
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008510059
—
VA
01
—
2102952
PK
—
Enumeration date
07/30/2006
Last updated
09/28/2016
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