Provider Demographics
NPI:1922201953
Name:COLES, CLARE RAYMOND (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:RAYMOND
Last Name:COLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 KNOLLWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-935-6584
Mailing Address - Fax:231-935-5667
Practice Address - Street 1:1105 6TH ST
Practice Address - Street 2:MUNSON MEDICAL CENTER PHARMACY
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-6584
Practice Address - Fax:231-935-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist