Healthcare Provider Details

I. General information

NPI: 1508060617
Provider Name (Legal Business Name): TERRY LEE COYLE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELLSVILLE BYP STE A R & S PULMONARY PHARMACY
CAMPBELLSVILLE KY
42718-7869
US

IV. Provider business mailing address

507 HASTINGS WAY
CAMPBELLSVILLE KY
42718-1618
US

V. Phone/Fax

Practice location:
  • Phone: 270-469-1328
  • Fax: 270-789-1994
Mailing address:
  • Phone: 270-465-3627
  • Fax: 270-789-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number006534
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: