Provider Demographics
NPI:1447266051
Name:COLONEL, JAMES F (RPH,, CPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:COLONEL
Suffix:
Gender:M
Credentials:RPH,, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3623
Mailing Address - Country:US
Mailing Address - Phone:954-987-5253
Mailing Address - Fax:954-987-3739
Practice Address - Street 1:3868 SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3623
Practice Address - Country:US
Practice Address - Phone:954-987-5253
Practice Address - Fax:954-987-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15889183500000X
MI5302025912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS15889OtherPHARMACIST LICENSE