Provider Demographics
NPI:1427669068
Name:COONS, ISABELLE MARY (RPH)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:MARY
Last Name:COONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5723 STRAND LOOP SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-9610
Mailing Address - Country:US
Mailing Address - Phone:505-412-8099
Mailing Address - Fax:
Practice Address - Street 1:13000 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4803
Practice Address - Country:US
Practice Address - Phone:505-298-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist