Healthcare Provider Details

I. General information

NPI: 1194979286
Provider Name (Legal Business Name): COCONUT GROVE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SW 27TH AVE SUITE 102
COCONUT GROVE FL
33133-4663
US

IV. Provider business mailing address

3001 SW 27TH AVE SUITE 102
COCONUT GROVE FL
33133-4663
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-0211
  • Fax: 305-442-8185
Mailing address:
  • Phone: 305-442-0211
  • Fax: 305-442-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23708
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES LYONS
Title or Position: MANAGER
Credential: RPH
Phone: 305-442-0211