Provider Demographics
NPI:1134744469
Name:COLE, JUSTIN CADE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CADE
Last Name:COLE
Suffix:
Gender:
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-4523
Mailing Address - Country:US
Mailing Address - Phone:580-381-0250
Mailing Address - Fax:
Practice Address - Street 1:400 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-1436
Practice Address - Country:US
Practice Address - Phone:580-688-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist