Provider Demographics
NPI:1063699981
Name:COFFEY, KIMBERLY ANN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LAKE HAVASU AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5651
Mailing Address - Country:US
Mailing Address - Phone:928-854-6300
Mailing Address - Fax:928-854-6363
Practice Address - Street 1:75 LAKE HAVASU AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5651
Practice Address - Country:US
Practice Address - Phone:928-854-6300
Practice Address - Fax:928-854-6363
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057859183500000X
AZS019119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist