MEDICARE: FLORIDA COAST PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH25434	FL

General Provider Information

NPI Number	:	1063707818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA COAST PHARMACY

Provider Business Mailing Address
First Line	:	9006 N 40TH STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9006 N 40TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-2428
Country	:	US
Telephone Number	:	317-441-8614
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SIMPLICE ESSOU
Credential	:
Telephone Number	:	317-441-8614

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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Directions to “FLORIDA COAST PHARMACY ” Practice Location

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