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General NPI Number Information
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NPI Number | 1538760830
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Entity Type | Individual
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Provider Name | TRACY BROOKE KUBENA COFFMAN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 8621 OHIO DR
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City | PLANO
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State | TX
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Zip | 75024-2264
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Country | US
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Telephone | 469-633-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 612 LONE FALCON LN
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City | FRISCO
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State | TX
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Zip | 75036-5146
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Country | US
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Telephone | 682-561-6148
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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 | 42443
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License Number State | TX
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