Healthcare Provider Details

I. General information

NPI: 1104984111
Provider Name (Legal Business Name): COAG THERAPEUTICS SOUTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 N JACKSON ST
MOBILE AL
36602-2809
US

IV. Provider business mailing address

53 N JACKSON ST
MOBILE AL
36602-2809
US

V. Phone/Fax

Practice location:
  • Phone: 251-432-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number112884
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number112884
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 251-432-2525