Provider Demographics
NPI:1508227455
Name:HAUGHBROOK, COLEMAN GARCIA
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:GARCIA
Last Name:HAUGHBROOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BLAIRSTONE RD # 301
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2877
Mailing Address - Country:US
Mailing Address - Phone:850-219-6211
Mailing Address - Fax:
Practice Address - Street 1:101 N BLAIRSTONE RD # 301
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2877
Practice Address - Country:US
Practice Address - Phone:850-219-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist