Basic Information
| Provider Information | |||||||||
| NPI: | 1356013676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 MICHIGAN ST. NE | ||||||||
| Address2: | MAIL CODE 9001 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164860646 | ||||||||
| FaxNumber: | 6164591909 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 MICHIGAN ST. NE | ||||||||
| Address2: | MAIL CODE 9001 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162678338 | ||||||||
| FaxNumber: | 6164591909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2021 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | 5302036332 | MI | Y |
ID Information
| ID | Type | State | Issuer | Description | 5302036332 | 01 | MI | STATE OF MICHIGAN PHARMACIST | OTHER |