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Organization
COVENTRY PLAZA PHARMACY INC
Active
Organization
COVENTRY PLAZA PHARMACY INC
Active
Other names
SOUTHSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SBEIH SBEIH RPH (OWNER)
(440) 277-0655
Entity
Organization
Contact information
Practice address
2811 FULTON RD, STE B, LORAIN, OH 44055-1638
(440) 277-0655
(440) 277-0651
Mailing address
2811 FULTON RD, STE B, LORAIN, OH 44055-1638
(440) 277-0655
(440) 277-0651
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
021599100
OH
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080565
PK
—
05
—
2701580
—
OH
Enumeration date
12/18/2006
Last updated
10/20/2014
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