Provider Demographics
NPI:1548469703
Name:COLSTON, RONALD JAMES
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:COLSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:JAMES
Other - Last Name:COLSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED PHARMACIS
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:231 HAYWARD/DUPONT ST
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-0456
Mailing Address - Country:US
Mailing Address - Phone:850-321-2867
Mailing Address - Fax:850-575-5529
Practice Address - Street 1:231 HAYWARD DUPONT RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-6502
Practice Address - Country:US
Practice Address - Phone:850-321-2867
Practice Address - Fax:850-575-5529
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS016289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist