Provider Demographics
NPI:1306976675
Name:COLSTON, JAMES MONROE (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MONROE
Last Name:COLSTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLARKESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-3215
Mailing Address - Country:US
Mailing Address - Phone:706-778-2258
Mailing Address - Fax:
Practice Address - Street 1:103 CLARKESVILLE ST
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-3215
Practice Address - Country:US
Practice Address - Phone:706-778-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist