Healthcare Provider Details

I. General information

NPI: 1841966736
Provider Name (Legal Business Name): BRIAN ROBERT COLE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 TIERRA REJADA RD
SIMI VALLEY CA
93065-2902
US

IV. Provider business mailing address

2327 ARCHWOOD LN UNIT 126
SIMI VALLEY CA
93063-6626
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-5791
  • Fax: 805-416-5792
Mailing address:
  • Phone: 805-990-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: