Healthcare Provider Details

I. General information

NPI: 1649589367
Provider Name (Legal Business Name): MR. STEVE BURKE COLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 HAZEL ST
ARCADIA LA
71001-4113
US

IV. Provider business mailing address

194 WOMACK RD
CHATHAM LA
71226-8855
US

V. Phone/Fax

Practice location:
  • Phone: 318-263-3948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10095
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: