Healthcare Provider Details

I. General information

NPI: 1740417922
Provider Name (Legal Business Name): COASTAL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 DIVISION ST STE B
BILOXI MS
39530-2969
US

IV. Provider business mailing address

10467 CORPORATE DR
GULFPORT MS
39503-4634
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-2494
  • Fax: 228-436-4258
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-396-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK HUTTO
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 228-394-2494