MEDICARE: COASTAL CARE 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	3336S0011X	Specialty Pharmacy	8384	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972894145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CARE PHARMACY INC

Provider Business Mailing Address
First Line	:	278 HWY 24
Second Line	:	SUITE M
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2582
Country	:	US
Telephone Number	:	252-726-0279
Fax Number	:	252-726-0792

Provider Business Practice Location Address
First Line	:	278 HWY 24
Second Line	:	SUITE M
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2582
Country	:	US
Telephone Number	:	252-726-0279
Fax Number	:	252-726-0792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FLETCHER JOHNSTON
Credential	:
Telephone Number	:	252-726-0279

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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