Provider Demographics
NPI:1578977138
Name:COLE, CHARMAN (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:CHARMAN
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S GEAR AVE
Mailing Address - Street 2:SUITE 154
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-768-3960
Mailing Address - Fax:319-768-3964
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-768-3960
Practice Address - Fax:319-768-3964
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18535183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-039925OtherILLINOIS PHARMACIST LICENSE
IA18535OtherIOWA PHARMACIST LICENSE