Provider Demographics
NPI:1730747148
Name:COLE, KATELYN ELISE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELISE
Last Name:COLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELISE
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2864 WOODRUFF ST
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-7394
Practice Address - Country:US
Practice Address - Phone:910-570-3134
Practice Address - Fax:910-396-7271
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-41421835P0018X, 1835P2201X
NC244251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty