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Organization
COASTAL PHARMACY LABS LLC
Active
Organization
COASTAL PHARMACY LABS LLC
Active
Other names
Coastal Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AL DIXON (OWNER)
(912) 756-3331
Entity
Organization
Contact information
Practice address
6709 FOREST PARK DR STE A, SAVANNAH, GA 31406-2587
(912) 354-5188
(912) 355-3685
Mailing address
6709 FOREST PARK DR STE A, SAVANNAH, GA 31406-2587
(912) 354-5188
(912) 355-3685
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PHRE009634
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141985
PK
—
Enumeration date
07/21/2008
Last updated
09/23/2013
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