Provider Demographics
NPI:1407657976
Name:COULARDOT, DUSTIN LEE (RPHT)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:LEE
Last Name:COULARDOT
Suffix:
Gender:
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4361
Mailing Address - Country:US
Mailing Address - Phone:740-653-2631
Mailing Address - Fax:740-653-5488
Practice Address - Street 1:111 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4361
Practice Address - Country:US
Practice Address - Phone:740-653-2631
Practice Address - Fax:740-653-5488
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician