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General NPI Number Information
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NPI Number | 1598009573
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Entity Type | Organization
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Legal Business Name | COASTAL SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 2050 W COUNTY HIGHWAY 30A M1-106
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0187
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Country | US
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Telephone | 850-622-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 W COUNTY HIGHWAY 30A M1-106
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0187
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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 | MGMR
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Name | JOAN ELLISON
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Credential | PHARMD
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Telephone | 850-622-3313
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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 |
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License Number State |
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