Provider Demographics
NPI:1255438198
Name:COLONIAL PHARMACY OF MURFREESBORO NC INC
Entity type:Organization
Organization Name:COLONIAL PHARMACY OF MURFREESBORO NC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-398-3138
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-0487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1214
Practice Address - Country:US
Practice Address - Phone:252-398-3138
Practice Address - Fax:252-398-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0465112Medicaid
3415381OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3415381OtherOTHER ID NUMBER-COMMERCIAL NUMBER