Healthcare Provider Details

I. General information

NPI: 1508043936
Provider Name (Legal Business Name): DARCY LEE CODDINGTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S MAIN ST
DE FOREST WI
53532-1421
US

IV. Provider business mailing address

645 S MAIN ST
DE FOREST WI
53532-1421
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-4736
  • Fax: 608-846-6092
Mailing address:
  • Phone: 608-846-4736
  • Fax: 608-846-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13478-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: