Provider Demographics
NPI:1215403910
Name:COON, KAY K
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:K
Last Name:COON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERRY
Other - Middle Name:
Other - Last Name:KOLWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:677 HILLCREST LOOP
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2663
Mailing Address - Country:US
Mailing Address - Phone:601-270-5154
Mailing Address - Fax:601-288-4163
Practice Address - Street 1:6051 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7201
Practice Address - Country:US
Practice Address - Phone:601-288-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-07987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist