Provider Demographics
NPI:1386885515
Name:EAST COAST PHARMACY LLC
Entity type:Organization
Organization Name:EAST COAST PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-213-4295
Mailing Address - Street 1:695 N WASHINGTON AVE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2101
Mailing Address - Country:US
Mailing Address - Phone:321-747-0600
Mailing Address - Fax:321-385-2180
Practice Address - Street 1:695 N WASHINGTON AVE
Practice Address - Street 2:UNIT 101
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2101
Practice Address - Country:US
Practice Address - Phone:321-747-0600
Practice Address - Fax:321-385-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH241393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001490800Medicaid
2121443OtherPK