Provider Demographics
NPI:1285857326
Name:GULFCOAST PHARMACEUTICALS
Entity Type:Organization
Organization Name:GULFCOAST PHARMACEUTICALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-644-4853
Mailing Address - Street 1:PO BOX 13524
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3524
Mailing Address - Country:US
Mailing Address - Phone:318-445-4477
Mailing Address - Fax:
Practice Address - Street 1:1039 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4757
Practice Address - Country:US
Practice Address - Phone:225-644-4853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538680Medicaid
LA1538680Medicaid
LA1074700001Medicare NSC