MEDICARE: GONCAN, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH 13892	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467472670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONCAN, INC

Provider Business Mailing Address
First Line	:	7050 SW 27TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-3757
Country	:	US
Telephone Number	:	954-962-2310
Fax Number	:	561-992-9330

Provider Business Practice Location Address
First Line	:	155 US HIGHWAY 27 S
Second Line	:
City	:	SOUTH BAY
State	:	FL
Zip	:	33493-2213
Country	:	US
Telephone Number	:	561-992-9220
Fax Number	:	561-992-9330

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	MR. GODWIN A NWAOBI
Credential	:	R.PH
Telephone Number	:	561-992-9220

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/01/2007

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Directions to “GONCAN, INC ” Practice Location

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