Provider Demographics
NPI:1790835833
Name:COAST, MICHAEL EDWARD (RPH,BCGP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:COAST
Suffix:
Gender:M
Credentials:RPH,BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WEST CANAL ST
Mailing Address - Street 2:PO BOX 191
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0191
Mailing Address - Country:US
Mailing Address - Phone:620-855-3693
Mailing Address - Fax:620-855-3411
Practice Address - Street 1:100 WEST AVE A
Practice Address - Street 2:SUITE B
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0191
Practice Address - Country:US
Practice Address - Phone:620-855-0095
Practice Address - Fax:620-855-3411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-122811835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric