Provider Demographics
NPI:1225173875
Name:COLE, REBECCA L (PHARM D)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:COLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:SCHROON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12870-0458
Mailing Address - Country:US
Mailing Address - Phone:518-532-7575
Mailing Address - Fax:518-532-9722
Practice Address - Street 1:1081 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCHROON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12870-0458
Practice Address - Country:US
Practice Address - Phone:518-532-7575
Practice Address - Fax:518-532-9722
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048422OtherSTATE LICENSE NUMBER