Provider Demographics
NPI:1609969237
Name:COAST, JAMES E (RPH,CGP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:COAST
Suffix:
Gender:M
Credentials:RPH,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 911
Mailing Address - Street 2:109 W KANSAS
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0911
Mailing Address - Country:US
Mailing Address - Phone:620-855-3398
Mailing Address - Fax:620-855-3616
Practice Address - Street 1:101 S MAIN
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0207
Practice Address - Country:US
Practice Address - Phone:620-855-2242
Practice Address - Fax:620-855-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist