Healthcare Provider Details

I. General information

NPI: 1801998612
Provider Name (Legal Business Name): COTO'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4982 W 12TH AVE
HIALEAH FL
33012-3115
US

IV. Provider business mailing address

4982 W 12TH AVE
HIALEAH FL
33012-3115
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-1430
  • Fax: 305-821-1321
Mailing address:
  • Phone: 305-821-1430
  • Fax: 305-821-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH6196
License Number StateFL

VIII. Authorized Official

Name: ALINA COTO TABIBI
Title or Position: PRESIDENT
Credential:
Phone: 305-821-1430