Provider Demographics
NPI:1265419899
Name:COKER, JAMES WILLARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLARD
Last Name:COKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9361
Mailing Address - Country:US
Mailing Address - Phone:417-753-7774
Mailing Address - Fax:417-753-7786
Practice Address - Street 1:317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9361
Practice Address - Country:US
Practice Address - Phone:417-753-7774
Practice Address - Fax:417-753-7786
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO359263209Medicaid