=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114880440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN COLE CPHT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2003 CHATBURN AVE
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51537-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-755-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2003 CHATBURN AVE
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51537-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-755-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 16094
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | PTCB-30298586
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 41104
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------