Healthcare Provider Details

I. General information

NPI: 1154800589
Provider Name (Legal Business Name): JODY LYNN COBURN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 COBURG RD
EUGENE OR
97401-4802
US

IV. Provider business mailing address

3655 W 13TH AVE APT 352
EUGENE OR
97402-3483
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-1464
  • Fax:
Mailing address:
  • Phone: 605-359-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16723
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: