Beverly O Coogler, RPH
Individual provider Active NPI Pharmacist · Locust Grove, GA
NPI 1619009313 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619009313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 014416 (GA)
- Practice address
- 3798 Highway 42
Locust Grove, GA 30248-3632 - Phone
- (770) 957-6004
- Fax
- (770) 914-0961
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014416 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 014416 | GA | Yes |
Addresses
Primary practice location
3798 Highway 42
Locust Grove, GA 30248-3632
Mailing address
199 Burg Rd
Jenkinsburg, GA 30234-2004
Phone (770) 775-2112
Other providers in Locust Grove, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.