Provider Demographics
NPI:1407011851
Name:THE LIME IN THE COCONUT SPECIALTY COMPOUNDING PHARMACY, LLC
Entity Type:Organization
Organization Name:THE LIME IN THE COCONUT SPECIALTY COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-964-6786
Mailing Address - Street 1:121 CROSSINGS WEST
Mailing Address - Street 2:# 6
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049
Mailing Address - Country:US
Mailing Address - Phone:573-964-6786
Mailing Address - Fax:573-964-5270
Practice Address - Street 1:121 CROSSINGS WEST
Practice Address - Street 2:# F
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049
Practice Address - Country:US
Practice Address - Phone:573-964-6786
Practice Address - Fax:573-964-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070050603336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy