MEDICARE: JODY LYNN COBURN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	16723	OR

General Provider Information

NPI Number	:	1154800589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY LYNN COBURN PHARMD

Provider Business Mailing Address
First Line	:	3655 W 13TH AVE APT 352
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-3483
Country	:	US
Telephone Number	:	605-359-6171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 COBURG RD
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4802
Country	:	US
Telephone Number	:	541-484-1464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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