Provider Demographics
NPI:1093597528
Name:COLE, BRANDON JAMES IAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES IAN
Last Name:COLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DUNMORE CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8522
Mailing Address - Country:US
Mailing Address - Phone:636-248-7861
Mailing Address - Fax:
Practice Address - Street 1:5503 DELMAR BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3122
Practice Address - Country:US
Practice Address - Phone:314-200-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist