Healthcare Provider Details

I. General information

NPI: 1790608354
Provider Name (Legal Business Name): COLE THOMAS O'CONNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 N SHADELAND AVE
INDIANAPOLIS IN
46250-2066
US

IV. Provider business mailing address

10233 HAREWOOD DR N
NOBLESVILLE IN
46060-4045
US

V. Phone/Fax

Practice location:
  • Phone: 317-595-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032134A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: