Provider Demographics
NPI:1225863798
Name:COLE, DANIEL LEONARD (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEONARD
Last Name:COLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CALGROVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-4638
Mailing Address - Country:US
Mailing Address - Phone:951-310-6040
Mailing Address - Fax:
Practice Address - Street 1:290 CALGROVE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-4638
Practice Address - Country:US
Practice Address - Phone:951-310-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024667183500000X
NV14638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist