MEDICARE: MARY ELIZABETH COYNER PHARMD

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	77628	CA

General Provider Information

NPI Number	:	1962066829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH COYNER PHARMD

Provider Business Mailing Address
First Line	:	3741 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5803
Country	:	US
Telephone Number	:	323-298-5595
Fax Number	:	323-298-5795

Provider Business Practice Location Address
First Line	:	3741 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5803
Country	:	US
Telephone Number	:	323-298-5595
Fax Number	:	323-298-5795

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

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	04/26/2019

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