Provider Demographics
NPI:1275173726
Name:COFFIN, JEAN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:COFFIN
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 1:300 500TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEARSBORO
Mailing Address - State:IA
Mailing Address - Zip Code:50242-7554
Mailing Address - Country:US
Mailing Address - Phone:319-240-5336
Mailing Address - Fax:
Practice Address - Street 1:110 S D ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3202
Practice Address - Country:US
Practice Address - Phone:641-673-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist