Provider Demographics
NPI:1992863286
Name:COASTAL PHARMACIES, LLC
Entity Type:Organization
Organization Name:COASTAL PHARMACIES, LLC
Other - Org Name:WALDPORT DRUG AND GIFT #1187
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKESLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-213-2236
Mailing Address - Street 1:916 W EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3035
Mailing Address - Country:US
Mailing Address - Phone:360-213-2236
Mailing Address - Fax:360-213-2238
Practice Address - Street 1:110 SW HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-3035
Practice Address - Country:US
Practice Address - Phone:541-563-4848
Practice Address - Fax:541-563-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0001011CS333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3813424OtherNCPDP PROVIDER IDENTIFICATION NUMBER