Provider Demographics
NPI:1801514690
Name:KITTERMAN, COLE MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:MICHAEL
Last Name:KITTERMAN
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 1:208 S ONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8815
Mailing Address - Country:US
Mailing Address - Phone:316-616-7957
Mailing Address - Fax:
Practice Address - Street 1:1510 OHIO ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2189
Practice Address - Country:US
Practice Address - Phone:316-775-5456
Practice Address - Fax:316-775-4108
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-107191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist