Provider Demographics
NPI:1972013951
Name:COLEMAN, KACIE SAMANTHA (PHARM-D)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:SAMANTHA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:SAMANTHA
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM-D
Mailing Address - Street 1:7 KENSINGTON LN UNIT 302
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1514
Practice Address - Country:US
Practice Address - Phone:203-386-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist