Healthcare Provider Details

I. General information

NPI: 1083624928
Provider Name (Legal Business Name): DEBORAH LYNN COULTER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

304 WEST SHERMAN ST PO BOX 476
MONROE IA
50170-0476
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number16059
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: