Provider Demographics
NPI:1912972639
Name:CORAL WEST PHARMACY
Entity Type:Organization
Organization Name:CORAL WEST PHARMACY
Other - Org Name:WESTCHESTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-1234
Mailing Address - Street 1:7245 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1401
Mailing Address - Country:US
Mailing Address - Phone:305-261-1234
Mailing Address - Fax:305-261-7221
Practice Address - Street 1:7245 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1401
Practice Address - Country:US
Practice Address - Phone:305-261-1234
Practice Address - Fax:305-261-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH14227333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103959800Medicaid
FL103959800Medicaid