Provider Demographics
NPI:1245392224
Name:COASTAL DRUG COMPANY LLC
Entity Type:Organization
Organization Name:COASTAL DRUG COMPANY LLC
Other - Org Name:COASTAL DRUG COMPANY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HARNISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-884-9255
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-0003
Mailing Address - Country:US
Mailing Address - Phone:912-884-9255
Mailing Address - Fax:912-884-9257
Practice Address - Street 1:204 BUTLER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320
Practice Address - Country:US
Practice Address - Phone:912-884-9255
Practice Address - Fax:912-884-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0052373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy