MEDICARE: COFFMAN AND HART LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1851047146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COFFMAN AND HART LLC

Provider Business Mailing Address
First Line	:	PO BOX 335
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-0335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 WESTERFIELD DR
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-2260
Country	:	US
Telephone Number	:	270-667-4227
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ADAM COFFMAN
Credential	:	PHARMD
Telephone Number	:	270-969-1364

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	06/27/2022

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Directions to “COFFMAN AND HART LLC ” Practice Location

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