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General NPI Number Information
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NPI Number | 1205453933
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Entity Type | Individual
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Provider Name | COLT COONEY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 2410 8TH ST S
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-6159
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Country | US
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Telephone | 715-423-2340
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Fax | 715-423-2349
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Provider Business Mailing Address
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Address Line | 2410 8TH ST S
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-6159
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Country | US
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Telephone | 715-423-2340
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Fax | 715-423-2349
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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 | 16121-40
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License Number State | WI
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