Healthcare Provider Details

I. General information

NPI: 1215171970
Provider Name (Legal Business Name): MICHAEL ANTHONY COLEMAN JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 04/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 PARADE ST
ERIE PA
16504-2811
US

IV. Provider business mailing address

2715 PARADE ST
ERIE PA
16504-2811
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-5148
  • Fax: 814-459-8086
Mailing address:
  • Phone: 814-454-5148
  • Fax: 814-459-8086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438941
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: