Provider Demographics
NPI:1346762846
Name:COFFEY, MARY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:COFFEY
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 1:2511 NEUDORF RD STE F
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8922
Mailing Address - Country:US
Mailing Address - Phone:336-703-8738
Mailing Address - Fax:
Practice Address - Street 1:2511 NEUDORF RD STE F
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8922
Practice Address - Country:US
Practice Address - Phone:336-703-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC181761835N1003X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support