Provider Demographics
NPI:1306171491
Name:COONS, NATHAN DAVID (PHARM D)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVID
Last Name:COONS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9043 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7049
Mailing Address - Country:US
Mailing Address - Phone:623-979-1383
Mailing Address - Fax:623-979-8167
Practice Address - Street 1:9043 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7049
Practice Address - Country:US
Practice Address - Phone:623-979-1383
Practice Address - Fax:623-979-8167
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist