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General NPI Number Information
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NPI Number | 1639516974
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Entity Type | Organization
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Legal Business Name | COIF - SOE
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 2700 W PLEASANT RUN RD # W250
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City | LANCASTER
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State | TX
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Zip | 75146-1079
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Country | US
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Telephone | 972-224-1340
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Fax | 972-224-1332
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Provider Business Mailing Address
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Address Line | PO BOX 486
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City | LANCASTER
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State | TX
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Zip | 75146-0486
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Country | US
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Telephone | 972-224-1340
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Fax | 972-224-1332
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Authorized Official
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Title or Position | PRESIDENT
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Name | IJEOMA AMADI
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Credential |
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Telephone | 972-224-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28564
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License Number State | TX
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