MEDICARE: COASTAL DRUG COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHRE005237	GA

General Provider Information

NPI Number	:	1245392224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL DRUG COMPANY LLC

Provider Business Mailing Address
First Line	:	PO BOX 3
Second Line	:
City	:	MIDWAY
State	:	GA
Zip	:	31320-0003
Country	:	US
Telephone Number	:	912-884-9255
Fax Number	:	912-884-9257

Provider Business Practice Location Address
First Line	:	204 BUTLER ST
Second Line	:
City	:	MIDWAY
State	:	GA
Zip	:	31320
Country	:	US
Telephone Number	:	912-884-9255
Fax Number	:	912-884-9257

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	HARNISH PATEL
Credential	:	RPH
Telephone Number	:	912-884-9255

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/09/2021

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Directions to “COASTAL DRUG COMPANY LLC ” Practice Location

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