Provider Demographics
NPI:1063478774
Name:CRYSTAL COAST PHARMACY
Entity Type:Organization
Organization Name:CRYSTAL COAST PHARMACY
Other - Org Name:CRYSTAL COAST PHARMACY & HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-393-3345
Mailing Address - Street 1:319 WB MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8516
Mailing Address - Country:US
Mailing Address - Phone:252-393-3345
Mailing Address - Fax:252-393-3346
Practice Address - Street 1:319 WB MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-8516
Practice Address - Country:US
Practice Address - Phone:252-393-3345
Practice Address - Fax:252-393-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046U8OtherBLUE CROSS BLUE SHIELD
NC7704096Medicaid
NC7704096Medicaid