Provider Demographics
NPI:1144569658
Name:COASTAL MEDS, LLC
Entity Type:Organization
Organization Name:COASTAL MEDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-388-1327
Mailing Address - Street 1:1759 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2154
Mailing Address - Country:US
Mailing Address - Phone:228-388-1327
Mailing Address - Fax:228-388-1329
Practice Address - Street 1:1759 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2154
Practice Address - Country:US
Practice Address - Phone:228-388-1327
Practice Address - Fax:228-388-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07783/02.23336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy