Provider Demographics
NPI:1154618726
Name:COLEMAN, MAUREEN ERIN
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ERIN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1087
Mailing Address - Country:US
Mailing Address - Phone:860-267-0732
Mailing Address - Fax:860-267-8709
Practice Address - Street 1:25 E HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1087
Practice Address - Country:US
Practice Address - Phone:860-267-0732
Practice Address - Fax:860-267-8709
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist