Provider Demographics
NPI:1790876985
Name:COLER DRUG NELSONVILLE
Entity Type:Organization
Organization Name:COLER DRUG NELSONVILLE
Other - Org Name:SHRIVERS PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-452-7685
Mailing Address - Street 1:40 WATKINS ST.
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-1452
Mailing Address - Country:US
Mailing Address - Phone:740-753-2484
Mailing Address - Fax:740-753-4185
Practice Address - Street 1:40 WATKINS ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764
Practice Address - Country:US
Practice Address - Phone:740-753-2484
Practice Address - Fax:740-753-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OH02-19242503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2886113Medicaid
OH6213580001Medicare NSC