Provider Demographics
NPI:1083219125
Name:COLA, MICHELE MARIE LUCIER
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE LUCIER
Last Name:COLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2105
Mailing Address - Country:US
Mailing Address - Phone:508-791-2579
Mailing Address - Fax:508-363-4763
Practice Address - Street 1:256 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2105
Practice Address - Country:US
Practice Address - Phone:508-791-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist