Provider Demographics
NPI:1235834755
Name:MEDCOAST PHARMACY CORP
Entity Type:Organization
Organization Name:MEDCOAST PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURMAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:747-253-7306
Mailing Address - Street 1:2040 GLENOAKS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1660
Mailing Address - Country:US
Mailing Address - Phone:747-253-7306
Mailing Address - Fax:747-253-7356
Practice Address - Street 1:2040 GLENOAKS BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1660
Practice Address - Country:US
Practice Address - Phone:747-253-7306
Practice Address - Fax:747-253-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy