Provider Demographics
NPI:1235400409
Name:COLE, ROBERT A (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:COLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11361 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4715
Mailing Address - Country:US
Mailing Address - Phone:804-379-9536
Mailing Address - Fax:804-897-5810
Practice Address - Street 1:11361 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4715
Practice Address - Country:US
Practice Address - Phone:804-379-9536
Practice Address - Fax:804-897-5810
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist