Provider Demographics
NPI:1245368067
Name:COFFMAN, CHRISTIE LYNNE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNNE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MIKITA DR
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5514
Mailing Address - Country:US
Mailing Address - Phone:814-673-4209
Mailing Address - Fax:
Practice Address - Street 1:3650 WALTON DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6775
Practice Address - Country:US
Practice Address - Phone:843-839-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040943L183500000X
PARPI000259183500000X
SC42792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist