Provider Demographics
NPI:1518547637
Name:COLE, JENNA MARIE (RPH, PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7839
Mailing Address - Country:US
Mailing Address - Phone:330-899-0653
Mailing Address - Fax:330-899-0691
Practice Address - Street 1:3875 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7839
Practice Address - Country:US
Practice Address - Phone:330-899-0653
Practice Address - Fax:330-899-0691
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist