Provider Demographics
NPI:1346543485
Name:COGGIN, SUSAN MOORE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MOORE
Last Name:COGGIN
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 1:850 STATLER BLVD
Mailing Address - Street 2:KROGER PHARMACY #343
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4880
Mailing Address - Country:US
Mailing Address - Phone:540-885-9875
Mailing Address - Fax:540-887-2520
Practice Address - Street 1:850 STATLER BLVD
Practice Address - Street 2:KROGER PHARMACY #343
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4880
Practice Address - Country:US
Practice Address - Phone:540-885-9875
Practice Address - Fax:540-887-2520
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202001816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist