Organization
COLONIAL DRUG INC
Active
Other names
COLONIAL DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNA BALYAN PHARM D (PRESIDENT/CEO)
(323) 666-4044
Entity
Organization
Contact information
Practice address
1727 N VERMONT AVE STE 107, LOS ANGELES, CA 90027-4343
(323) 666-4044
(323) 662-5674
Mailing address
1727 N VERMONT AVE STE 107, LOS ANGELES, CA 90027-4343
(323) 666-4044
(323) 662-5674
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY58247
BOARD OF PHARMACY
CA
Enumeration date
01/09/2007
Last updated
09/21/2021
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