Provider Demographics
NPI:1043481302
Name:COFFEY, CYNTHIA W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:W
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 J CLYDE MORRIS BLVD STE 326
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1929
Mailing Address - Country:US
Mailing Address - Phone:757-612-7681
Mailing Address - Fax:757-223-7686
Practice Address - Street 1:500 J CLYDE MORRIS BLVD STE 326
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-612-7681
Practice Address - Fax:757-223-7686
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56702183500000X
GARPH020952183500000X
VA0202205372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202205372OtherPHARMACIST LICENSE