Provider Demographics
NPI:1457622029
Name:COFFMAN, KAREN DENISE (R PH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:COOK
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R PH
Mailing Address - Street 1:108 BLACKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3000
Mailing Address - Country:US
Mailing Address - Phone:432-425-2267
Mailing Address - Fax:
Practice Address - Street 1:108 BLACKBERRY CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:432-425-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist