Provider Demographics
NPI:1245585140
Name:ELGIN, KATHRYN COGHLAN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COGHLAN
Last Name:ELGIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 HIGHWAY 4 W
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-7578
Mailing Address - Country:US
Mailing Address - Phone:662-252-0872
Mailing Address - Fax:662-252-1656
Practice Address - Street 1:145 E VAN DORN AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3025
Practice Address - Country:US
Practice Address - Phone:662-252-2321
Practice Address - Fax:662-252-1656
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist