Healthcare Provider Details

I. General information

NPI: 1841124369
Provider Name (Legal Business Name): COLE MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 MILWAUKEE RD
BELOIT WI
53511-6915
US

IV. Provider business mailing address

10155 CLEARWING LN UNIT 1
ROSCOE IL
61073-1200
US

V. Phone/Fax

Practice location:
  • Phone: 608-362-0057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23346-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: