Provider Demographics
NPI:1336497031
Name:COFFMAN FAMILY DRUGS LLC
Entity Type:Organization
Organization Name:COFFMAN FAMILY DRUGS LLC
Other - Org Name:NORTONVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-676-8250
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:NORTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42442-0967
Mailing Address - Country:US
Mailing Address - Phone:270-676-8250
Mailing Address - Fax:270-676-8205
Practice Address - Street 1:102 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42442
Practice Address - Country:US
Practice Address - Phone:270-676-8268
Practice Address - Fax:270-676-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075183336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209310Medicaid
2136833OtherPK