Provider Demographics
NPI:1114328994
Name:PRIOLEAU-COLES, TASHEKA MARIA (CERT PHARMACY TECH)
Entity Type:Individual
Prefix:MRS
First Name:TASHEKA
Middle Name:MARIA
Last Name:PRIOLEAU-COLES
Suffix:
Gender:F
Credentials:CERT PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CARSON ST NE
Mailing Address - Street 2:NONE
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-2408
Mailing Address - Country:US
Mailing Address - Phone:912-312-1589
Mailing Address - Fax:
Practice Address - Street 1:302 HARMON AVENUE PHARMACY (INPATIENT PHARMACY)
Practice Address - Street 2:WINN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20944183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician