Provider Demographics
NPI:1932298619
Name:E & T PHARMACY LLC
Entity Type:Organization
Organization Name:E & T PHARMACY LLC
Other - Org Name:COASTAL COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EPHREM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGEFU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-683-1095
Mailing Address - Street 1:3111 45TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1981
Mailing Address - Country:US
Mailing Address - Phone:561-683-1095
Mailing Address - Fax:561-683-0591
Practice Address - Street 1:3111 45TH ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1981
Practice Address - Country:US
Practice Address - Phone:561-683-1095
Practice Address - Fax:561-683-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH222573336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007665OtherPK