Healthcare Provider Details

I. General information

NPI: 1902137250
Provider Name (Legal Business Name): MOLETHA J COLEMAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CENTURY CENTER PKWY SUITE 12
MEMPHIS TN
38134-8827
US

IV. Provider business mailing address

1680 CENTURY CENTER PKWY SUITE 12
MEMPHIS TN
38134-8827
US

V. Phone/Fax

Practice location:
  • Phone: 901-386-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number24541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: