Provider Demographics
NPI:1205975778
Name:COATS PHARMACY INC
Entity type:Organization
Organization Name:COATS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LISCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-897-8500
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:393 N MCKINLEY ST
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0811
Mailing Address - Country:US
Mailing Address - Phone:910-897-8500
Mailing Address - Fax:910-897-5114
Practice Address - Street 1:393 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521-8132
Practice Address - Country:US
Practice Address - Phone:910-897-8500
Practice Address - Fax:910-897-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09283333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700108Medicaid
NC0435206Medicaid
NC3417880OtherNABP
NCC08403183OtherMEDICARE SUBMITTER ID
NC3417880OtherNABP
NC0471370001Medicare NSC