Provider Demographics
NPI:1952407496
Name:COLE, LARRY D (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:COLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 VALLEY BEND DR
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-7763
Mailing Address - Country:US
Mailing Address - Phone:828-779-3937
Mailing Address - Fax:
Practice Address - Street 1:163 VALLEY BEND DR
Practice Address - Street 2:
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-7763
Practice Address - Country:US
Practice Address - Phone:828-779-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC008576183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy