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General NPI Number Information
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NPI Number | 1821330150
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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 | 03/25/2013
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Last Update Date | 03/25/2013
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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 |
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Provider Business Mailing Address
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Address Line | 1035 COLLIER CENTER WAY SUITE 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 |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | ALICIA GAZDA
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Credential |
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Telephone | 239-324-9619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH26491
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License Number State | FL
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