Provider Demographics
NPI:1740570506
Name:COLE, MOHAMMED LEADI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:LEADI
Last Name:COLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3838
Mailing Address - Country:US
Mailing Address - Phone:717-397-6179
Mailing Address - Fax:717-391-9682
Practice Address - Street 1:59 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3838
Practice Address - Country:US
Practice Address - Phone:717-397-6179
Practice Address - Fax:717-391-9682
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030377L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist