Healthcare Provider Details

I. General information

NPI: 1184618894
Provider Name (Legal Business Name): COASTAL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 ELMA G MILES PKWY
HINESVILLE GA
31313-4006
US

IV. Provider business mailing address

PO BOX 1060
RICHMOND HILL GA
31324-1060
US

V. Phone/Fax

Practice location:
  • Phone: 912-876-8125
  • Fax: 912-876-4387
Mailing address:
  • Phone: 912-756-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020913
License Number StateGA

VIII. Authorized Official

Name: MR. ALEX S TUCKER
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 912-756-3331