Provider Demographics
NPI:1730798059
Name:COON, MARY CATHERINE (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:COON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:405 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-2631
Mailing Address - Country:US
Mailing Address - Phone:318-559-2400
Mailing Address - Fax:318-559-3468
Practice Address - Street 1:405 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-2631
Practice Address - Country:US
Practice Address - Phone:318-559-2400
Practice Address - Fax:318-559-3468
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist