# GULF COAST PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gulf Coast Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184917429
- **Authorized official:** DAVID BUSH (PHARMACIST)
- **Authorized official phone:** (251) 404-3343

## Contact information

- **Practice address:** 515 AZALEA RD, MOBILE, AL 36609-1501
- **Practice address phone:** (251) 342-5519
- **Mailing address:** 515 AZALEA RD, MOBILE, AL 36609-1501
- **Mailing address phone:** (251) 342-5519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 113142 | AL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |
| 3336N0007X | Nuclear Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/19/2011
- **Last updated:** 09/27/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0137162 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |