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General NPI Number Information
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NPI Number | 1528267499
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Entity Type | Organization
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Legal Business Name | COASTAL PHARMACY LLC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 504 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 321-747-0206
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Fax | 321-593-4319
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Provider Business Mailing Address
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Address Line | 112 FIG TREE RUN
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City | LONGWOOD
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State | FL
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Zip | 32750-4065
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Country | US
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Telephone | 321-747-0206
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DEEPAK AGGARWAL
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Credential | RPH
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Telephone | 321-747-0206
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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 | PH22782
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License Number State | FL
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