MEDICARE: FIVE POINTS PHARMACY OF COCOA LLC

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	PH25694	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5708093	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1972880276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE POINTS PHARMACY OF COCOA LLC

Provider Business Mailing Address
First Line	:	1108 LAKE DR
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32922-8678
Country	:	US
Telephone Number	:	321-636-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 LAKE DR
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32922-8678
Country	:	US
Telephone Number	:	321-636-8433
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLINTON WRIGHT
Credential	:
Telephone Number	:	321-806-3951

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	03/20/2024

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