Provider Demographics
NPI:1154096931
Name:COLE, CELY J (RPH)
Entity Type:Individual
Prefix:
First Name:CELY
Middle Name:J
Last Name:COLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SW 131ST LN
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3105
Mailing Address - Country:US
Mailing Address - Phone:904-514-5535
Mailing Address - Fax:
Practice Address - Street 1:15801 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-3487
Practice Address - Country:US
Practice Address - Phone:954-442-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist