Provider Demographics
NPI:1336645381
Name:COLDAR
Entity Type:Organization
Organization Name:COLDAR
Other - Org Name:SHRIVERSPHARMACY #10
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-452-7685
Mailing Address - Street 1:PO BOX 3506
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-3506
Mailing Address - Country:US
Mailing Address - Phone:740-452-7685
Mailing Address - Fax:740-452-7665
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1029
Practice Address - Country:US
Practice Address - Phone:740-452-7685
Practice Address - Fax:740-452-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OH022865450-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176707OtherPK