Provider Demographics
NPI:1578876405
Name:COETZEE, NICHOLAS JOACHIM (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOACHIM
Last Name:COETZEE
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-3409
Mailing Address - Country:US
Mailing Address - Phone:207-255-3458
Mailing Address - Fax:207-255-6064
Practice Address - Street 1:144 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3409
Practice Address - Country:US
Practice Address - Phone:207-255-3458
Practice Address - Fax:207-255-6064
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist