Active NPI
Tracy Michelle Coffman
- Geriatric Pharmacist
- Pocatello, ID
National Provider Identifier
1043840754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- P5360
- Practice address
- 1023 Yellowstone Ave Ste J
Pocatello, ID 83201-4478 - Phone
- (208) 233-2444
- Fax
- (208) 912-0950
- NPI assigned
- Jan 22, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | P5360 | ID | Primary |
Addresses
Primary practice location
1023 Yellowstone Ave Ste J
Pocatello, ID 83201-4478
Mailing address
1023 Yellowstone Ave Ste J
Pocatello, ID 83201-4478
Phone (208) 233-2444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P5360 | ID | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1043840754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1023 YELLOWSTONE AVE STE J",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014478",
"telephone_number": "208-233-2444",
"fax_number": "208-912-0950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1023 YELLOWSTONE AVE STE J",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014478",
"telephone_number": "208-233-2444",
"fax_number": "208-912-0950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFMAN",
"first_name": "TRACY",
"middle_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "ID",
"license": "P5360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.