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NPI Code Detail

MEDICARE: MR. DUSTIN LEE COULARDOT CPHT

MEDICARE: MR. DUSTIN LEE COULARDOT CPHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy Technician

General Provider Information

NPI Number : 1407657976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUSTIN LEE COULARDOT CPHT
Provider Business Mailing Address
First Line : 111 S MEMORIAL DR
Second Line :
City : LANCASTER
State : OH
Zip : 43130-4361
Country : US
Telephone Number : 740-653-2631
Fax Number : 740-653-5488
Provider Business Practice Location Address
First Line : 111 S MEMORIAL DR
Second Line :
City : LANCASTER
State : OH
Zip : 43130-4361
Country : US
Telephone Number : 740-653-2631
Fax Number : 740-653-5488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2025
Last Update Date : 03/16/2026

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