Provider Demographics
NPI:1235573056
Name:TEARE, COLE RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:RYAN
Last Name:TEARE
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 1:3702 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5453
Mailing Address - Country:US
Mailing Address - Phone:307-638-0192
Mailing Address - Fax:307-638-5070
Practice Address - Street 1:2255 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1488
Practice Address - Country:US
Practice Address - Phone:303-772-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3537183500000X
CO19164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist