Provider Demographics
NPI:1114149432
Name:COLEMAN, RONALD STEPHEN (RPH, MPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:STEPHEN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:RPH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 ALTER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3104
Mailing Address - Country:US
Mailing Address - Phone:313-821-2738
Mailing Address - Fax:
Practice Address - Street 1:DETROIT HEALTH DEPT. - HERMAN KIEFER PHARMACY
Practice Address - Street 2:1151 TAYLOR STREET, 41B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4018
Practice Address - Fax:313-876-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist