Provider Demographics
NPI:1417284159
Name:COLE, JUSTIN WESLEY (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WESLEY
Last Name:COLE
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1965
Mailing Address - Country:US
Mailing Address - Phone:937-324-1111
Mailing Address - Fax:937-322-3368
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-3498
Practice Address - Fax:614-722-2189
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist