Provider Demographics
NPI:1164764189
Name:COLEMAN, CASSIE LAUREL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:LAUREL
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 1:150 E SWAN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1446
Mailing Address - Country:US
Mailing Address - Phone:931-729-6798
Mailing Address - Fax:931-729-6799
Practice Address - Street 1:150 E SWAN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1446
Practice Address - Country:US
Practice Address - Phone:931-729-6798
Practice Address - Fax:931-729-6799
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35983OtherTN PHARMACIST LICENSE NO.