MEDICARE: DR. PENNY SUE COLEMAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302033063	MI

General Provider Information

NPI Number	:	1073640637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY SUE COLEMAN PHARMD

Provider Business Mailing Address
First Line	:	4036 SWEET RD
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-8817
Country	:	US
Telephone Number	:	517-546-8701
Fax Number	:	517-540-1282

Provider Business Practice Location Address
First Line	:	1002 E GRAND RIVER AVE
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-1718
Country	:	US
Telephone Number	:	517-546-8701
Fax Number	:	517-540-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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