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General NPI Number Information
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NPI Number | 1427307461
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Entity Type | Organization
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Legal Business Name | INNOVATIVERX GULF COAST PHARMACY INC
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 1035 COLLIER CENTER WAY STE 2
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City | NAPLES
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State | FL
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Zip | 34110-8474
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Country | US
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Telephone | 239-324-9619
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Fax | 239-280-1226
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Provider Business Mailing Address
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Address Line | 8222 118TH AVE SUITE 605
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City | LARGO
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State | FL
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Zip | 33773-5053
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Country | US
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Telephone | 239-324-9619
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Fax | 239-280-1226
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID MACNEAL
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Credential |
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Telephone | 727-631-9140
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH26348
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License Number State | FL
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