Provider Demographics
NPI:1952692170
Name:COLE, DARWIN REID (BS)
Entity type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:REID
Last Name:COLE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1026
Mailing Address - Country:US
Mailing Address - Phone:423-267-5088
Mailing Address - Fax:
Practice Address - Street 1:3401 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1026
Practice Address - Country:US
Practice Address - Phone:423-267-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012119183500000X
TN011916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist