Provider Demographics
NPI:1326117664
Name:COASTAL PHARMACEUTICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:COASTAL PHARMACEUTICAL SERVICES CORPORATION
Other - Org Name:COASTAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILOLAHTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-282-2382
Mailing Address - Street 1:6912 S QUENTIN ST STE 50
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4531
Mailing Address - Country:US
Mailing Address - Phone:720-282-5325
Mailing Address - Fax:877-676-0493
Practice Address - Street 1:1833 PORTOLA RD UNIT J
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8094
Practice Address - Country:US
Practice Address - Phone:805-981-2500
Practice Address - Fax:805-981-8447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 333600000X, 335G00000X
CAPHY 525413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5616668OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA472380Medicaid
BC9463907OtherDEA
CALSC 100738OtherBOARD OF PHARMACY
CAPHY 52541OtherBOARD OF PHARMACY
5551280001Medicare NSC