Provider Demographics
NPI:1619250966
Name:COLEMAN, MARLENE COLETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:COLETTE
Last Name:COLEMAN
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 1:4562 MEADOWFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2516
Mailing Address - Country:US
Mailing Address - Phone:314-487-1699
Mailing Address - Fax:
Practice Address - Street 1:100 ADMIRAL WEINEL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1993
Practice Address - Country:US
Practice Address - Phone:618-281-2111
Practice Address - Fax:618-281-2115
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist