Provider Demographics
NPI:1104954981
Name:COUGHLIN, JEFFREY M (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:COUGHLIN
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 1:65 NATICOOK AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-8036
Mailing Address - Country:US
Mailing Address - Phone:603-424-6851
Mailing Address - Fax:
Practice Address - Street 1:1631 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1207
Practice Address - Country:US
Practice Address - Phone:603-623-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist