Provider Demographics
NPI:1972589679
Name:COLONIAL DRUGS OF ORLANDO, LLC
Entity Type:Organization
Organization Name:COLONIAL DRUGS OF ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-647-2311
Mailing Address - Street 1:155 E NEW ENGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4330
Mailing Address - Country:US
Mailing Address - Phone:407-647-2311
Mailing Address - Fax:407-647-1687
Practice Address - Street 1:155 E NEW ENGLAND AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4330
Practice Address - Country:US
Practice Address - Phone:407-647-2311
Practice Address - Fax:407-647-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24127333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106416900Medicaid
FL106416900Medicaid