Provider Demographics
NPI:1619287828
Name:COYLE, ROSE MARY (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROSE MARY
Middle Name:
Last Name:COYLE
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 1:895 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2737
Mailing Address - Country:US
Mailing Address - Phone:207-766-3179
Mailing Address - Fax:207-828-7816
Practice Address - Street 1:895 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2737
Practice Address - Country:US
Practice Address - Phone:207-766-3179
Practice Address - Fax:207-828-7816
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04251183500000X
CTPCT.0011555183500000X
MEPR6339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist