Coastal Pharmacy Labs LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHRE009634 Issued in GA

Legal business name

COASTAL PHARMACY LABS LLC

Doing business as

Coastal Compounding Pharmacy

Practice address

6709 Forest Park Dr Ste a
Savannah, GA 31406-2587

Phone

(912) 354-5188

Fax

(912) 355-3685

NPI assigned

Jul 21, 2008

Last updated

Sep 23, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Al Dixon

Title

Owner

Phone

(912) 756-3331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coastal Compounding Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1477718385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6709 FOREST PARK DR STE A",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062587",
            "telephone_number": "912-354-5188",
            "fax_number": "912-355-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6709 FOREST PARK DR STE A",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062587",
            "telephone_number": "912-354-5188",
            "fax_number": "912-355-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PHARMACY LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-21",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-756-3331"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "GA",
            "license": "PHRE009634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141985",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Savannah, GA
• Providers in Savannah, GA by specialty
• Compounding Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.