| NPI | 1912976630 |
|---|---|
| Doing Business As | COLISEUM PARK PROFESSIONAL PHARMACY |
| Entity Type | Organization |
| Authorized Contact | ROBERT BENJAMIN MOODY President 478-745-5431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: GA PHRE004996) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2020-08-22 |