Provider Demographics
NPI:1396468302
Name:COUGHLIN, ALEXANDER D
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:D
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 1/2 N SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7053
Mailing Address - Country:US
Mailing Address - Phone:813-516-9143
Mailing Address - Fax:
Practice Address - Street 1:3461 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6302
Practice Address - Country:US
Practice Address - Phone:813-662-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI41782390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI41782OtherFLORIDA DEPT OF HEALTH / BOARD OF PHARMACY