Provider Demographics
NPI:1023507308
Name:COFFMAN, SHELDON KEITH JR (RPH)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:KEITH
Last Name:COFFMAN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28263 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-6232
Mailing Address - Country:US
Mailing Address - Phone:352-442-1884
Mailing Address - Fax:
Practice Address - Street 1:14306 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3434
Practice Address - Country:US
Practice Address - Phone:352-567-2238
Practice Address - Fax:352-567-2259
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist