Organization
COLLEYVILLE DRUG, INC
Active
Other names
REGIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINT TYLER MANSKE RPH (OWNER)
(806) 549-1243
Entity
Organization
Contact information
Practice address
622 W MAIN ST, CROSBYTON, TX 79322-2243
(806) 675-2001
(806) 675-7284
Mailing address
622 W MAIN ST, CROSBYTON, TX 79322-2243
(806) 675-2001
(806) 675-7284
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148716
—
TX
Enumeration date
08/14/2006
Last updated
07/19/2024
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