Provider Demographics
NPI:1689131625
Name:COASTAL BEND WELLNESS FOUNDATION INC.
Entity Type:Organization
Organization Name:COASTAL BEND WELLNESS FOUNDATION INC.
Other - Org Name:COASTAL BEND WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1436
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:361-792-2502
Practice Address - Street 1:2882 HOLLY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-4106
Practice Address - Country:US
Practice Address - Phone:833-789-5307
Practice Address - Fax:361-792-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150594Medicaid