GULF COAST MEDICAL PHARMACY INC
Managed Care Organizations in Fort Myers, FL

License number
Florida PH20076
Category
Managed Care Organizations
Type
Health Maintenance Organization
Owner
Name: MR. JEFFREY R. GREEN
Title: OWNER
Phone: (239) 278-3969
Address
Address
13685 Doctors Way Suite #150, Fort Myers, FL 33912
National Provider ID: 1568535870
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GULF COAST MEDICAL PHARMACY, INC

Fort Myers, FL

Status:
Inactive
Industry:
Compounds IV Infusion Mail Order Pharmacy Retail Pharmacy Humans and Animals
Doing business as:
Leader Drug Store
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Aug 30, 2002
Inactive since:
Oct 20, 2004
Phone:
(239) 574-8424 (Phone)
Addresses:
8359 Beacon Blvd 213, Fort Myers, FL 33907 (Physical)
8359 Beacon Blvd, Fort Myers, FL 33907
13691 Metro Pkwy, Fort Myers, FL 33912
13685 Doctors Way, Fort Myers, FL 33912
State ID:
P02000094669
Business type:
Florida Profit Corporation
President, Director, Secretary:
Jeffrey R Green (President, Director, Secretary), 12900 Eagle Rd, Cape Coral, FL 33909 (Physical)
Agent:
Robert Winesett,2248 1 St, Fort Myers, FL 33902 (Physical)
EIN:
56-2289411

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