Provider Demographics
NPI:1053942300
Name:COFFMAN, JOHN MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MIKITA DR
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5514
Mailing Address - Country:US
Mailing Address - Phone:814-673-4208
Mailing Address - Fax:
Practice Address - Street 1:2709 CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4440
Practice Address - Country:US
Practice Address - Phone:843-365-0301
Practice Address - Fax:843-375-0318
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42811183500000X
PARP040017L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist