Organization
COLONY PRESCRIPTION SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL W RUSS RPH (PHARMACIST IN CHARGE)
(229) 686-2088
Entity
Organization
Contact information
Practice address
1230 E MCPHERSON ST, NASHVILLE, GA 31639-2369
(229) 686-2088
(229) 686-2088
Mailing address
1230 E MCPHERSON ST, NASHVILLE, GA 31639-2369
(229) 686-2088
(229) 686-2088
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE005581
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000025242A
—
GA
Enumeration date
03/07/2007
Last updated
06/04/2008
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