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General NPI Number Information
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NPI Number | 1285139030
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Entity Type | Organization
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Legal Business Name | COFFEE RX LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 106 S MAYS ST STE 100
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City | ROUND ROCK
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State | TX
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Zip | 78664
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Country | US
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Telephone | 512-238-1146
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Fax | 512-238-1148
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Provider Business Mailing Address
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Address Line | 106 S MAYS ST STE 100
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City | ROUND ROCK
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State | TX
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Zip | 78664-5850
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Country | US
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Telephone | 512-238-1146
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Fax | 512-238-1148
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/AO
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Name | VAN COWAN
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Credential |
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Telephone | 512-466-2966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31891
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License Number State | TX
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