MEDICARE: DR. BRENDON COUGHRAN 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	183500000X	Pharmacist	PI22956	AR

General Provider Information

NPI Number	:	1578383360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDON COUGHRAN PHARMD

Provider Business Mailing Address
First Line	:	500 GREEN MOUNTAIN CIR APT 2
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2635
Country	:	US
Telephone Number	:	501-944-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 GREEN MOUNTAIN CIR APT 2
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2635
Country	:	US
Telephone Number	:	501-944-2558
Fax Number	:

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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