Provider Demographics
NPI:1861067720
Name:COFFIE, DEYSIA SUSAN (RPH)
Entity type:Individual
Prefix:
First Name:DEYSIA
Middle Name:SUSAN
Last Name:COFFIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEYSIA
Other - Middle Name:SUSAN
Other - Last Name:COFFIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:300 LAKE PALMS DR APT 302
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-5597
Mailing Address - Country:US
Mailing Address - Phone:407-797-3372
Mailing Address - Fax:
Practice Address - Street 1:5101 E BUSCH BLVD STE 9
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5380
Practice Address - Country:US
Practice Address - Phone:813-820-0570
Practice Address - Fax:813-756-2151
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist