Provider Demographics
NPI:1659820447
Name:COASTLINE PHARMACY LLC
Entity Type:Organization
Organization Name:COASTLINE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-781-0011
Mailing Address - Street 1:2107 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-7321
Mailing Address - Country:US
Mailing Address - Phone:866-758-1957
Mailing Address - Fax:866-766-4183
Practice Address - Street 1:2107 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477
Practice Address - Country:US
Practice Address - Phone:866-758-1957
Practice Address - Fax:866-766-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH307263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy