Provider Demographics
NPI:1891103156
Name:COAST QUALITY PHARMACY LLC
Entity Type:Organization
Organization Name:COAST QUALITY PHARMACY LLC
Other - Org Name:ANAZAOHEALTH CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-882-4500
Mailing Address - Street 1:5710 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5339
Mailing Address - Country:US
Mailing Address - Phone:800-995-4363
Mailing Address - Fax:800-985-4363
Practice Address - Street 1:5710 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5339
Practice Address - Country:US
Practice Address - Phone:800-995-4363
Practice Address - Fax:800-985-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH283693336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147712OtherPK