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General NPI Number Information
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NPI Number | 1881900074
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Entity Type | Organization
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Legal Business Name | EMERALD COAST COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 7 TOWN CENTER LOOP UNIT C-15
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-8736
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Country | US
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Telephone | 850-628-6243
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Fax | 850-622-0580
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Provider Business Mailing Address
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Address Line | 19 TOWN CENTER LOOP UNIT 1-B
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0700
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Country | US
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Telephone | 850-628-6243
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Fax | 850-622-0580
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. GEORGE THOMAS FLOWERS
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Credential | RPH
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Telephone | 850-628-6243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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