Provider Demographics
NPI:1710760996
Name:COLEMAN'S PHARMACY
Entity Type:Organization
Organization Name:COLEMAN'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:700-200-9050
Mailing Address - Street 1:319 E EATON ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-1806
Mailing Address - Country:US
Mailing Address - Phone:731-200-9050
Mailing Address - Fax:731-200-9119
Practice Address - Street 1:319 E EATON ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-1806
Practice Address - Country:US
Practice Address - Phone:731-200-9050
Practice Address - Fax:731-200-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy