Provider Demographics
NPI:1548556954
Name:COLEY, EDWARD R (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:R
Last Name:COLEY
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 1:2309 COMMONWEALTH AVE.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5129
Mailing Address - Country:US
Mailing Address - Phone:704-344-1187
Mailing Address - Fax:
Practice Address - Street 1:2115 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4307
Practice Address - Country:US
Practice Address - Phone:704-394-5026
Practice Address - Fax:704-393-9135
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist