Provider Demographics
NPI:1770147258
Name:COOMES, MARK JOHN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHN
Last Name:COOMES
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 LAKE CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4656
Mailing Address - Country:US
Mailing Address - Phone:727-403-7089
Mailing Address - Fax:
Practice Address - Street 1:590 LAKE CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4656
Practice Address - Country:US
Practice Address - Phone:727-403-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist