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General NPI Number Information
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NPI Number | 1255953790
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Entity Type | Organization
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Legal Business Name | COASTAL LABORATORIES, INC.
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 4530 E SHEA BLVD STE 165
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City | PHOENIX
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State | AZ
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Zip | 85028-6042
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Country | US
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Telephone | 410-212-9937
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Fax |
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Provider Business Mailing Address
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Address Line | 2 COMPROMISE ST
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1819
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Country | US
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Telephone | 410-212-9937
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | PATRICK TORMAY BRITTON-HARR
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Credential |
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Telephone | 410-212-9937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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