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General NPI Number Information
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NPI Number | 1134146848
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Entity Type | Organization
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Legal Business Name | COFFMAN DRUG STORE INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 303 N STATE ST
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City | LITCHFIELD
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State | IL
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Zip | 62056-2002
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Country | US
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Telephone | 217-532-5324
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | LITCHFIELD
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State | IL
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Zip | 62056-0218
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Country | US
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Telephone | 217-556-6396
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Fax | 217-342-3242
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEOFFREY BRAUER
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Credential |
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Telephone | 217-324-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054008935
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License Number State | IL
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