MEDICARE: COASTAL MEDICAL SERVICES LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE000346	GA

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
2	2014514	OTHER		PK

General Provider Information

NPI Number	:	1992791974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL MEDICAL SERVICES LLC

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	:	912-756-5904

Provider Business Practice Location Address
First Line	:	4700 WATERS AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31404-6220
Country	:	US
Telephone Number	:	912-350-6337
Fax Number	:	912-350-7457

Authorized Official
Title or Position	:	PRESIDENT OWNER PHARMACIST
Name	:	ALEX TUCKER
Credential	:	PHARMD
Telephone Number	:	912-756-3331

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	03/18/2025

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Directions to “COASTAL MEDICAL SERVICES LLC ” Practice Location

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