Provider Demographics
NPI:1730484650
Name:COLEMAN, CARLA MCKEE (DPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MCKEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-0664
Mailing Address - Country:US
Mailing Address - Phone:931-289-5995
Mailing Address - Fax:931-289-5997
Practice Address - Street 1:5897 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-0664
Practice Address - Country:US
Practice Address - Phone:931-289-5995
Practice Address - Fax:931-289-5997
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist