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General NPI Number Information
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NPI Number | 1346100336
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Entity Type | Organization
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Legal Business Name | COAST RX
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1105 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2415
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Country | US
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Telephone | 504-301-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RYAN BOUDREAU
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Credential | PHARMD
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Telephone | 504-301-6638
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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 |
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License Number State |
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