Provider Demographics
NPI:1841966736
Name:COLE, BRIAN ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:COLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 ARCHWOOD LN UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6626
Mailing Address - Country:US
Mailing Address - Phone:805-990-3715
Mailing Address - Fax:
Practice Address - Street 1:51 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2902
Practice Address - Country:US
Practice Address - Phone:805-416-5791
Practice Address - Fax:805-416-5792
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist