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General NPI Number Information
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NPI Number | 1568535870
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Entity Type | Organization
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Legal Business Name | GULF COAST MEDICAL PHARMACY INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 13685 DOCTORS WAY SUITE #150
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City | FORT MYERS
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State | FL
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Zip | 33912-4336
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Country | US
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Telephone | 239-278-3969
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Fax | 239-278-0336
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Provider Business Mailing Address
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Address Line | 13685 DOCTORS WAY SUITE #150
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City | FT.MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-278-3969
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Fax | 239-278-0336
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY R. GREEN
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Credential |
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Telephone | 239-278-3969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | PH20076
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License Number State | FL
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