MEDICARE: MR. EDWARD R COLEY R.PH.

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
1	183500000X	Pharmacist	10056	NC

General Provider Information

NPI Number	:	1548556954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD R COLEY R.PH.

Provider Business Mailing Address
First Line	:	2309 COMMONWEALTH AVE.
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5129
Country	:	US
Telephone Number	:	704-344-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4307
Country	:	US
Telephone Number	:	704-394-5026
Fax Number	:	704-393-9135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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