Provider Demographics
NPI:1215553508
Name:COASTAL PHARMACY AND COMPOUNDING
Entity Type:Organization
Organization Name:COASTAL PHARMACY AND COMPOUNDING
Other - Org Name:KINGS PHARMACY AND COMPOUNDING LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:IV
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:910-452-7098
Mailing Address - Street 1:2231 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5546
Mailing Address - Country:US
Mailing Address - Phone:910-452-7098
Mailing Address - Fax:
Practice Address - Street 1:2231 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5546
Practice Address - Country:US
Practice Address - Phone:910-452-7098
Practice Address - Fax:910-452-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy