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General NPI Number Information
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NPI Number | 1184917429
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Entity Type | Organization
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Legal Business Name | GULF COAST PHARMACY LLC
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 515 AZALEA RD
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City | MOBILE
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State | AL
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Zip | 36609-1501
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Country | US
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Telephone | 251-342-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 515 AZALEA RD
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City | MOBILE
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State | AL
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Zip | 36609-1501
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Country | US
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Telephone | 251-342-5519
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DAVID BUSH
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Credential |
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Telephone | 251-404-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 113142
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License Number State | AL
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