Provider Demographics
NPI:1881630390
Name:COLEMAN FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:COLEMAN FAMILY PHARMACY, INC.
Other - Org Name:COLEMAN FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-465-6661
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-0514
Mailing Address - Country:US
Mailing Address - Phone:989-465-6661
Mailing Address - Fax:989-465-6222
Practice Address - Street 1:211 E RAILWAY ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618-9799
Practice Address - Country:US
Practice Address - Phone:989-465-6661
Practice Address - Fax:989-465-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010082013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040758OtherPK
2040758OtherPK
MI2313310Medicaid