# COFFMAN DRUG STORE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COFFMAN DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134146848
- **Authorized official:** GEOFFREY BRAUER (PRESIDENT)
- **Authorized official phone:** (217) 324-3255

## Contact information

- **Practice address:** 303 N STATE ST, LITCHFIELD, IL 62056-2002
- **Practice address phone:** (217) 532-5324
- **Mailing address:** PO BOX 218, LITCHFIELD, IL 62056-0218
- **Mailing address phone:** (217) 556-6396
- **Mailing address fax:** (217) 342-3242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054008935 | IL | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 08/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1405655 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |