MEDICARE: DR. ROBERT PAUL COFFEY MS, PHARM D., BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	5302022556	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302022556	OTHER	MI	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1821099250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT PAUL COFFEY MS, PHARM D., BCPS

Provider Business Mailing Address
First Line	:	580 FORSTROM DR
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9380
Country	:	US
Telephone Number	:	616-915-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 FORSTROM DR
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9380
Country	:	US
Telephone Number	:	616-915-6221
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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