MEDICARE: COASTAL PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	020913	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104075	OTHER	GA	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184618894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-1060
Country	:	US
Telephone Number	:	912-756-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	481 ELMA G MILES PKWY
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-4006
Country	:	US
Telephone Number	:	912-876-8125
Fax Number	:	912-876-4387

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. ALEX S TUCKER
Credential	:	PHARMD
Telephone Number	:	912-756-3331

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/28/2025

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