Organization
COLOSSEUM, INC.
Active
Other names
ER DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAAD KOUZA R PH (PHARMACIST)
(734) 955-9110
Entity
Organization
Contact information
Practice address
27260 EUREKA RD, TAYLOR, MI 48180-4845
(734) 955-9110
(734) 955-9101
Mailing address
27260 EUREKA RD, TAYLOR, MI 48180-4845
(734) 955-9110
(734) 955-9101
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
5301007587
MI
3336C0003X
Community/Retail Pharmacy
Primary
5301007587
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4431348
—
MI
01
—
540H221480
BLUE CROSS BLUE SHEILD
MI
Enumeration date
10/18/2006
Last updated
04/03/2017
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