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General NPI Number Information
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NPI Number | 1053942300
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Entity Type | Individual
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Provider Name | JOHN MICHAEL COFFMAN RPH
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Gender | Male
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 03/30/2024
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Provider Practice Location Address
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Address Line | 2709 CHURCH ST STE A
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City | CONWAY
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State | SC
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Zip | 29526-4440
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Country | US
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Telephone | 843-365-0301
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Fax | 843-375-0318
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Provider Business Mailing Address
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Address Line | 342 MIKITA DR
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-5514
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Country | US
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Telephone | 814-673-4208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42811
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP040017L
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License Number State | PA
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