=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184067167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA J COEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2013
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1046 6TH AVE SW
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97321-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-812-4730
-----------------------------------------------------
Fax | 541-812-4719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3247 INDIAN WELLS LOOP S
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302-9679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-666-0586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 0014213
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------