MEDICARE: GONCAN, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	PH13892	FL

General Provider Information

NPI Number	:	1902995871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONCAN, INC

Provider Business Mailing Address
First Line	:	155 US HIGHWAY 27 S
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2213
Country	:	US
Telephone Number	:	561-992-9220
Fax Number	:	561-992-9330

Provider Business Practice Location Address
First Line	:	155 US HIGHWAY 27 S
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2213
Country	:	US
Telephone Number	:	561-992-9220
Fax Number	:	561-992-9330

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. GODWIN A NWAOBI
Credential	:	R.PH
Telephone Number	:	561-992-9220

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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Directions to “GONCAN, INC ” Practice Location

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