1205922457 NPI number — COLES PHARMACY

Table of content: (NPI 1205922457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205922457 NPI number — COLES PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLES PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205922457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 S MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16933-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-662-2351
Provider Business Mailing Address Fax Number:
570-662-3738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16933-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-662-2351
Provider Business Practice Location Address Fax Number:
570-662-3738
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRONG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
OWNER RPH
Authorized Official Telephone Number:
570-662-2351

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP410435L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000561747 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3919341 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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