Healthcare Provider Details

I. General information

NPI: 1568350767
Provider Name (Legal Business Name): CROWN COAST PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 C AVE STE A
CORONADO CA
92118-1423
US

IV. Provider business mailing address

11322 PEPPERVIEW TER
SAN DIEGO CA
92131-3769
US

V. Phone/Fax

Practice location:
  • Phone: 760-960-2689
  • Fax:
Mailing address:
  • Phone: 760-960-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ARASH KOHAN
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 760-960-2689