Provider Demographics
NPI:1760984017
Name:CROWN COLONY PHARMACY INC
Entity Type:Organization
Organization Name:CROWN COLONY PHARMACY INC
Other - Org Name:CROWN COLONY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-472-9000
Mailing Address - Street 1:500 CONGRESS ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0917
Mailing Address - Country:US
Mailing Address - Phone:617-472-9000
Mailing Address - Fax:617-472-8700
Practice Address - Street 1:500 CONGRESS ST STE 1B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0917
Practice Address - Country:US
Practice Address - Phone:617-472-9000
Practice Address - Fax:617-472-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MADS902473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176293OtherPK