Organization
COFFEE RX LLC
Active
Organization
COFFEE RX LLC
Active
Other names
Industria Coffee & Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VAN COWAN (PHARMACIST IN CHARGE/AO)
(512) 466-2966
Entity
Organization
Contact information
Practice address
106 S MAYS ST STE 100, ROUND ROCK, TX 78664
(512) 238-1146
(512) 238-1148
Mailing address
106 S MAYS ST STE 100, ROUND ROCK, TX 78664-5850
(512) 238-1146
(512) 238-1148
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176356
PK
—
Enumeration date
03/26/2018
Last updated
08/16/2018
Update your record
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