=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609241496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT KING COLE RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2015
-----------------------------------------------------
Last Update Date | 12/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1229 TAVERNIER KNOLL LN
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-490-1101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1229 TAVERNIER KNOLL LN
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-490-1101
-----------------------------------------------------
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 | 25672
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------