# COVENTRY PLAZA PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHSIDE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225191851
- **Authorized official:** SBEIH SBEIH RPH (OWNER)
- **Authorized official phone:** (440) 277-0655

## Contact information

- **Practice address:** 2811 FULTON RD, STE B, LORAIN, OH 44055-1638
- **Practice address phone:** (440) 277-0655
- **Practice address fax:** (440) 277-0651
- **Mailing address:** 2811 FULTON RD, STE B, LORAIN, OH 44055-1638
- **Mailing address phone:** (440) 277-0655
- **Mailing address fax:** (440) 277-0651

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 021599100 | OH | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 10/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2080565 | PK | — |
| 05 | — | 2701580 | — | OH |