Provider Demographics
NPI:1851409841
Name:COENEN, JAMES L (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:COENEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 KEOKUK AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7610
Mailing Address - Country:US
Mailing Address - Phone:712-336-4573
Mailing Address - Fax:712-262-1716
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4364
Practice Address - Country:US
Practice Address - Phone:712-262-2343
Practice Address - Fax:712-262-1716
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist