Provider Demographics
NPI:1770805046
Name:COGHLAN, CHRISTY K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:K
Last Name:COGHLAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CHRISTY
Other - Middle Name:K
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:941 CHEROKEE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3646
Mailing Address - Country:US
Mailing Address - Phone:660-886-5558
Mailing Address - Fax:660-886-7000
Practice Address - Street 1:941 CHEROKEE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3646
Practice Address - Country:US
Practice Address - Phone:660-886-5558
Practice Address - Fax:660-886-7000
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist