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General NPI Number Information
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NPI Number | 1205922457
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Entity Type | Organization
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Legal Business Name | COLES PHARMACY
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 2 S MAIN STREET
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City | MANSFIELD
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State | PA
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Zip | 16933-1508
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Country | US
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Telephone | 570-662-2351
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Fax | 570-662-3738
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Provider Business Mailing Address
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Address Line | 2 S MAIN STREET
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City | MANSFIELD
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State | PA
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Zip | 16933-1508
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Country | US
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Telephone | 570-662-2351
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Fax | 570-662-3738
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Authorized Official
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Title or Position | OWNER RPH
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Name | MR. ROBERT GEORGE STRONG
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Credential | RPH
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Telephone | 570-662-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP410435L
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License Number State | PA
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