Provider Demographics
NPI:1073793402
Name:COLUMBIA PHARMACY LLC
Entity Type:Organization
Organization Name:COLUMBIA PHARMACY LLC
Other - Org Name:COLUMBIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATCOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:410-902-0039
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-0005
Mailing Address - Country:US
Mailing Address - Phone:410-715-4777
Mailing Address - Fax:410-715-4778
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:410-715-4777
Practice Address - Fax:410-715-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP046843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133697OtherNCPDP PROVIDER IDENTIFICATION NUMBER