MEDICARE: MR. MARK JOHN COOMES PHARMACIST

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	183500000X	Pharmacist	PS28012	FL

General Provider Information

NPI Number	:	1770147258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JOHN COOMES PHARMACIST

Provider Business Mailing Address
First Line	:	590 LAKE CYPRESS CIR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4656
Country	:	US
Telephone Number	:	727-403-7089
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 LAKE CYPRESS CIR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4656
Country	:	US
Telephone Number	:	727-403-7089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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Directions to “ MR. MARK JOHN COOMES PHARMACIST” Practice Location

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