Provider Demographics
NPI:1265792048
Name:COATESVILLE PHARMACY
Entity type:Organization
Organization Name:COATESVILLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VENKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDAPUNENI
Authorized Official - Suffix:
Authorized Official - Credentials:VG
Authorized Official - Phone:302-339-0130
Mailing Address - Street 1:270 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3408
Mailing Address - Country:US
Mailing Address - Phone:610-380-8520
Mailing Address - Fax:610-380-8530
Practice Address - Street 1:270 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3408
Practice Address - Country:US
Practice Address - Phone:610-380-8520
Practice Address - Fax:610-380-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4822773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy