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General NPI Number Information
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NPI Number | 1205473378
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE FIVECOATE RPH
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Gender | Female
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Dates
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Enumeration Date | 12/07/2019
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Last Update Date | 12/07/2019
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Provider Practice Location Address
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Address Line | 605 N DIXON RD ATTENTION PHARMACY DEPARTMENT
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City | KOKOMO
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State | IN
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Zip | 46901
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Country | US
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Telephone | 765-457-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N 600 W
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City | KOKOMO
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State | IN
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Zip | 46901-3761
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Country | US
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Telephone | 765-210-5512
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Fax | 765-454-5286
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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 | 26017244A
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License Number State | IN
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