MEDICARE: COASTAL COMMUNITY HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1588497028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL COMMUNITY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	100 PROFESSIONAL CENTER DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-6743
Country	:	US
Telephone Number	:	912-574-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 POOLER PKWY STE 107
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4423
Country	:	US
Telephone Number	:	912-333-8255
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAVANAUGH CHANDLER
Credential	:	MD
Telephone Number	:	912-275-8028

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	01/29/2025

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