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General NPI Number Information
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NPI Number | 1528483393
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Entity Type | Organization
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Legal Business Name | COASTAL MEDS
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 1759 MEDICAL PARK DR STE. C
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City | BILOXI
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State | MS
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Zip | 39532-2154
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Country | US
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Telephone | 228-388-1327
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 MEDICAL PARK DRIVE STE. C
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City | BILOXI
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State | MS
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Zip | 39532
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Country | US
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Telephone | 228-388-1327
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSEPH ALLEN JOHNSON
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Credential |
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Telephone | 228-388-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 07783/2.2
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License Number State | MS
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