Organization
COLLEYVILLE DRUG, INC
Active
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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