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General NPI Number Information
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NPI Number | 1578436085
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Entity Type | Individual
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Provider Name | RICHARD COCA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 207 S LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-2544
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Country | US
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Telephone | 765-482-3630
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WHEAT RDG
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City | COLLINSVILLE
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State | IL
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Zip | 62234-2240
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Country | US
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Telephone |
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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 | 26031487A
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License Number State | IN
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