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General NPI Number Information
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NPI Number | 1962968404
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Entity Type | Organization
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Legal Business Name | COASTAL PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 190 GREENBRIER BLVD STE 105
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City | COVINGTON
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State | LA
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Zip | 70433-7237
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Country | US
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Telephone | 985-900-2416
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Fax | 985-900-2436
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Provider Business Mailing Address
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Address Line | 1922 HIGHWAY 22 W STE A
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City | MADISONVILLE
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State | LA
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Zip | 70447-9490
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Country | US
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Telephone | 985-792-9001
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Fax | 985-792-9004
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUNTER FARRAR
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Credential | PHARMD
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Telephone | 985-792-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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