Provider Demographics
NPI:1457881468
Name:GAYHEART, COLEMAN JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:COLEMAN
Middle Name:
Last Name:GAYHEART
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12981 SW UPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9212
Mailing Address - Country:US
Mailing Address - Phone:541-306-0655
Mailing Address - Fax:
Practice Address - Street 1:12981 SW UPPER RIDGE RD
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-9212
Practice Address - Country:US
Practice Address - Phone:541-306-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR87391835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care