Provider Demographics
NPI:1952905002
Name:COUGHLIN, TERAH ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:ANNE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:IL
Mailing Address - Zip Code:60479-0054
Mailing Address - Country:US
Mailing Address - Phone:815-735-5546
Mailing Address - Fax:
Practice Address - Street 1:106 WATTERS DR
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-2200
Practice Address - Country:US
Practice Address - Phone:815-584-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist