Provider Demographics
NPI:1821408311
Name:COLE, JOHN JR (CPHT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:COLE
Suffix:JR
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NICHOLBY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4232
Mailing Address - Country:US
Mailing Address - Phone:484-480-2214
Mailing Address - Fax:
Practice Address - Street 1:4 CREEK PARKWAY
Practice Address - Street 2:PENTEC HEALTH
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061
Practice Address - Country:US
Practice Address - Phone:610-494-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE5601070189247183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician