MEDICARE: LARRY SAMUEL COY PHARMD

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	183500000X	Pharmacist	PS56396	FL

General Provider Information

NPI Number	:	1619477999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY SAMUEL COY PHARMD

Provider Business Mailing Address
First Line	:	4565 21ST PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 20TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-4632
Country	:	US
Telephone Number	:	772-778-1202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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