Provider Demographics
NPI:1629783303
Name:COAST DISCOUNT DRUGS LLC
Entity Type:Organization
Organization Name:COAST DISCOUNT DRUGS LLC
Other - Org Name:COAST DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-365-6222
Mailing Address - Street 1:753 E SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4620
Mailing Address - Country:US
Mailing Address - Phone:228-596-1270
Mailing Address - Fax:
Practice Address - Street 1:1105 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2415
Practice Address - Country:US
Practice Address - Phone:228-206-7005
Practice Address - Fax:228-206-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy