Healthcare Provider Details

I. General information

NPI: 1578977138
Provider Name (Legal Business Name): CHARMAN COLE PHARMD, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE SUITE 154
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

1225 S GEAR AVE SUITE 154
WEST BURLINGTON IA
52655-1691
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3960
  • Fax: 319-768-3964
Mailing address:
  • Phone: 319-768-3960
  • Fax: 319-768-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18535
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number18535
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: