Provider Demographics
NPI:1922174481
Name:COGGINS, MARK DARRIN (PHARMD, CGP, FASCP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DARRIN
Last Name:COGGINS
Suffix:
Gender:M
Credentials:PHARMD, CGP, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7186
Mailing Address - Country:US
Mailing Address - Phone:864-599-5222
Mailing Address - Fax:479-478-2560
Practice Address - Street 1:476 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-7186
Practice Address - Country:US
Practice Address - Phone:864-599-5222
Practice Address - Fax:479-478-2560
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81451835G0303X
NC121181835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC924OtherCOMMISSION FOR CERTIFICATION IN GERIATRIC PHARMACY