Provider Demographics
NPI:1891881769
Name:COLLEGE PHARMACY, INC. ANT
Entity Type:Organization
Organization Name:COLLEGE PHARMACY, INC. ANT
Other - Org Name:COLLEGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:719-262-0022
Mailing Address - Street 1:3505 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5702
Mailing Address - Country:US
Mailing Address - Phone:719-262-0022
Mailing Address - Fax:719-262-0035
Practice Address - Street 1:4217 S NEW HOP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:866-828-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC087883336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy