Provider Demographics
NPI:1619160702
Name:COLONIA CARE PHARMACY
Entity Type:Organization
Organization Name:COLONIA CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MILIC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-381-3400
Mailing Address - Street 1:515 INMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1114
Mailing Address - Country:US
Mailing Address - Phone:732-381-3400
Mailing Address - Fax:732-381-7665
Practice Address - Street 1:515 INMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1114
Practice Address - Country:US
Practice Address - Phone:732-381-3400
Practice Address - Fax:732-381-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006705003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy