Provider Demographics
NPI:1396402707
Name:COFFIN, COLLEEN MARGURIETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARGURIETTE
Last Name:COFFIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81511 DAVISSON RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9865
Mailing Address - Country:US
Mailing Address - Phone:541-521-0565
Mailing Address - Fax:
Practice Address - Street 1:12749 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:SWISSHOME
Practice Address - State:OR
Practice Address - Zip Code:97480-9612
Practice Address - Country:US
Practice Address - Phone:541-521-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist