Provider Demographics
NPI:1194435529
Name:COLE, WILLIAM D
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7377 BURR OAK AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4594
Mailing Address - Country:US
Mailing Address - Phone:612-402-8786
Mailing Address - Fax:
Practice Address - Street 1:2021 6TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-3007
Practice Address - Country:US
Practice Address - Phone:612-624-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34868183500000X
MI5302413325183500000X
MN121712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist