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General NPI Number Information
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NPI Number | 1063824787
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Entity Type | Organization
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Legal Business Name | COASTAL CARE PHARMACY LLC
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 11939 PANAMA CITY BEACH PKWY
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City | PANAMA CITY
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State | FL
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Zip | 32407-2605
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Country | US
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Telephone | 850-346-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 7895 HIGHWAY 119 SUITE 1
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City | ALABASTER
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State | AL
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Zip | 35007
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Country | US
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Telephone | 850-346-8868
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | CHARLES J SHIRLEY
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Credential |
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Telephone | 205-246-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28172
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License Number State | FL
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