Provider Demographics
NPI:1275135915
Name:COFFMAN, RALPH LEONARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LEONARD
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 S ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8174
Mailing Address - Country:US
Mailing Address - Phone:989-854-6438
Mailing Address - Fax:
Practice Address - Street 1:SAM'S CLUB PHARMACY
Practice Address - Street 2:4850 ENCORE BLVD
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-5814
Practice Address - Fax:989-773-5825
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist