Provider Demographics
NPI:1528039716
Name:COLE, MARY J (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:COLE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WOOD ROAD
Mailing Address - Street 2:NAVAL HEALTH CLINIC
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-5050
Mailing Address - Country:US
Mailing Address - Phone:410-293-4378
Mailing Address - Fax:
Practice Address - Street 1:250 WOOD ROAD
Practice Address - Street 2:NAVAL HEALTH CLINIC
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-5050
Practice Address - Country:US
Practice Address - Phone:410-293-4378
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA13055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN