Provider Demographics
NPI:1740417922
Name:COASTAL FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:COASTAL FAMILY HEALTH CENTER, INC.
Other - Org Name:COASTAL FAMILY HEALTH CENTER - PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-394-2494
Mailing Address - Street 1:1046 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2935
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-436-4258
Practice Address - Street 1:1025 DIVISION ST
Practice Address - Street 2:STE A
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2906
Practice Address - Country:US
Practice Address - Phone:228-374-2494
Practice Address - Fax:228-436-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9013185Medicaid