Healthcare Provider Details

I. General information

NPI: 1952637936
Provider Name (Legal Business Name): COASTAL MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N NIMITZ HWY STE 115B
HONOLULU HI
96817-5380
US

IV. Provider business mailing address

74 N PECOS RD STE B
HENDERSON NV
89074-7344
US

V. Phone/Fax

Practice location:
  • Phone: 808-545-2500
  • Fax: 808-545-2500
Mailing address:
  • Phone: 808-545-2500
  • Fax: 808-545-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MICHAEL SEINK
Title or Position: SECRETARY
Credential:
Phone: 808-545-2500