1639454721 NPI number — DR. VALERIE RYDBERG COLE PHARMD

Table of content: DR. VALERIE RYDBERG COLE PHARMD (NPI 1639454721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639454721 NPI number — DR. VALERIE RYDBERG COLE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
VALERIE
Provider Middle Name:
RYDBERG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

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:
1639454721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 BURROW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27295-9087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-455-4849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2912 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKERTOWN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27051-9324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-595-2638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  21822 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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