1417419177 NPI number — DR. LINDSAY ANN COULTER PHARMD

Table of content: DR. LINDSAY ANN COULTER PHARMD (NPI 1417419177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417419177 NPI number — DR. LINDSAY ANN COULTER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COULTER
Provider First Name:
LINDSAY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TARLETON
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417419177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4299 MAHONING AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44483-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-806-3137
Provider Business Mailing Address Fax Number:
234-806-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4299 MAHONING AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44483-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-806-3137
Provider Business Practice Location Address Fax Number:
234-806-3138
Provider Enumeration Date:
04/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  03135715 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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