Provider Demographics
NPI:1073640637
Name:COLEMAN, PENNY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:SUE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8817
Mailing Address - Country:US
Mailing Address - Phone:517-546-8701
Mailing Address - Fax:517-540-1282
Practice Address - Street 1:1002 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1718
Practice Address - Country:US
Practice Address - Phone:517-546-8701
Practice Address - Fax:517-540-1282
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist