Provider Demographics
NPI:1568963924
Name:WILLIAMS, COLE BRADLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:BRADLEY
Last Name:WILLIAMS
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 1:6410 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3008
Mailing Address - Country:US
Mailing Address - Phone:815-397-2127
Mailing Address - Fax:815-397-2747
Practice Address - Street 1:6410 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3008
Practice Address - Country:US
Practice Address - Phone:815-397-2127
Practice Address - Fax:815-397-2747
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4219183500000X
IL051294250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist