=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548040413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAYNA VANCE COLE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2023
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 ESTATOA AVE
-----------------------------------------------------
City | NEWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28657-7832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-733-0061
-----------------------------------------------------
Fax | 828-733-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 LITTLE BUCK HILL RD
-----------------------------------------------------
City | NEWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28657-9806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-467-4852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28010
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------