Organization
COLLEGE PHARMACY, INC.
Active
Other names
COLLEGE PHARMACY VITAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ROUNDTREE (MANAGER)
(912) 489-4525
Entity
Organization
Contact information
Practice address
35 S MAIN STREE, STATESBORO, GA 30458
(912) 489-4525
(912) 489-3129
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE007767
GA
332BC3200X
Customized Equipment (DME)
PHRE007767
GA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHRE007767
GA
332BX2000X
Oxygen Equipment & Supplies (DME)
PHRE007767
GA
333600000X
Pharmacy
PHRE007767
GA
3336C0003X
Community/Retail Pharmacy
PHRE007767
GA
3336H0001X
Home Infusion Therapy Pharmacy
PHRE007767
GA
3336L0003X
Long Term Care Pharmacy
PHRE007767
GA
3336M0002X
Mail Order Pharmacy
PHRE007767
GA
3336S0011X
Specialty Pharmacy
Primary
PHRE007767
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003
CHAMPUS TRICARE
—
05
—
00159596A
—
GA
01
—
469715
HIT
—
Enumeration date
08/29/2006
Last updated
09/11/2025
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