Provider Demographics
NPI:1215959887
Name:COLPHARM INC
Entity type:Organization
Organization Name:COLPHARM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:590-458-5573
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17846-0477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:538 S STATE ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:PA
Practice Address - Zip Code:17846
Practice Address - Country:US
Practice Address - Phone:570-458-5573
Practice Address - Fax:570-458-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412844L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007631190004Medicaid
3944003OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007631190004Medicaid