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General NPI Number Information
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NPI Number | 1669098240
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Entity Type | Organization
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Legal Business Name | COASTAL FRIENDLY PHARMACY
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 1204 E MAIN ST
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City | HAVELOCK
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State | NC
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Zip | 28532-2405
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Country | US
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Telephone | 252-444-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 E MAIN ST
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City | HAVELOCK
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State | NC
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Zip | 28532-2405
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Country | US
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Telephone | 252-444-1061
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | TARA-DAWN R TOOTLE
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Credential | PHARMD
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Telephone | 252-444-1061
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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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