Provider Demographics
NPI:1760559553
Name:DAVIDSON, COLE (RPH)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:DAVIDSON
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 1:2025 CEDAR DR NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5768
Mailing Address - Country:US
Mailing Address - Phone:605-882-2478
Mailing Address - Fax:605-886-0721
Practice Address - Street 1:1320 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5302
Practice Address - Country:US
Practice Address - Phone:605-886-0661
Practice Address - Fax:605-886-0721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist