Provider Demographics
NPI:1043380470
Name:FIRST COLONY CORP
Entity Type:Organization
Organization Name:FIRST COLONY CORP
Other - Org Name:COLONIAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-526-2233
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-0010
Mailing Address - Country:US
Mailing Address - Phone:603-526-2233
Mailing Address - Fax:603-526-2235
Practice Address - Street 1:82 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5414
Practice Address - Country:US
Practice Address - Phone:603-526-2233
Practice Address - Fax:603-526-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3001043OtherNAPB
NH3094084Medicaid