Provider Demographics
NPI:1336224914
Name:COLES, W. JOHN (CPHT)
Entity Type:Individual
Prefix:MR
First Name:W.
Middle Name:JOHN
Last Name:COLES
Suffix:
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 1:5349 S 4100 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-7727
Mailing Address - Country:US
Mailing Address - Phone:801-985-1613
Mailing Address - Fax:801-525-5279
Practice Address - Street 1:1580 W ANTELOPE DR STE 130A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1173
Practice Address - Country:US
Practice Address - Phone:801-525-5277
Practice Address - Fax:801-525-5279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5040990-1717183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician