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General NPI Number Information
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NPI Number | 1134744469
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Entity Type | Individual
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Provider Name | JUSTIN CADE COLE DOCTOR OF PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 400 E SYCAMORE ST
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City | HOLLIS
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State | OK
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Zip | 73550-1436
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Country | US
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Telephone | 580-688-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 N PARK LN
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City | ALTUS
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State | OK
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Zip | 73521-4523
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Country | US
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Telephone | 580-381-0250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18036
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License Number State | OK
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