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General NPI Number Information
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NPI Number | 1184618894
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Entity Type | Organization
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Legal Business Name | COASTAL PHARMACY, INC.
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 481 ELMA G MILES PKWY
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City | HINESVILLE
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State | GA
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Zip | 31313-4006
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Country | US
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Telephone | 912-876-8125
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Fax | 912-876-4387
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | RICHMOND HILL
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State | GA
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Zip | 31324-1060
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Country | US
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Telephone | 912-756-3331
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ALEX S TUCKER
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Credential | PHARMD
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Telephone | 912-756-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 020913
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License Number State | GA
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