Provider Demographics
NPI:1558907162
Name:COASTAL BEND CANCER CENTER PHARMACY LLC
Entity Type:Organization
Organization Name:COASTAL BEND CANCER CENTER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEHGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-887-0067
Mailing Address - Street 1:PO BOX 81346
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1346
Mailing Address - Country:US
Mailing Address - Phone:361-887-0067
Mailing Address - Fax:361-883-1484
Practice Address - Street 1:1625 RODD FIELD RD STE 100-A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-561-5843
Practice Address - Fax:361-883-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy