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
—
—
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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