Provider Demographics
NPI:1760812689
Name:REARDEN, COLE B (PHARM D)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:B
Last Name:REARDEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5418
Mailing Address - Country:US
Mailing Address - Phone:480-215-2284
Mailing Address - Fax:
Practice Address - Street 1:630 S 6TH ST W
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5418
Practice Address - Country:US
Practice Address - Phone:480-215-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist