Provider Demographics
NPI:1235653916
Name:COASTAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:COASTAL PHARMACY SERVICES LLC
Other - Org Name:COASTAL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:985-900-4857
Mailing Address - Street 1:1922 HIGHWAY 22 W STE A
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9490
Mailing Address - Country:US
Mailing Address - Phone:985-792-9001
Mailing Address - Fax:985-792-9004
Practice Address - Street 1:1922 HIGHWAY 22 W STE A
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9490
Practice Address - Country:US
Practice Address - Phone:985-792-9001
Practice Address - Fax:985-792-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332BP3500X, 333600000X, 3336L0003X, 3336L0003X, 3336S0011X, 3336C0004X
LAPHY.007511-IR3336H0001X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170909OtherPK
LA2206672Medicaid