Provider Demographics
NPI:1932393923
Name:COBURN, JATHAN COLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JATHAN
Middle Name:COLE
Last Name:COBURN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5208
Mailing Address - Country:US
Mailing Address - Phone:405-273-9906
Mailing Address - Fax:405-273-2349
Practice Address - Street 1:1442 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5208
Practice Address - Country:US
Practice Address - Phone:405-273-9906
Practice Address - Fax:405-273-2349
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist