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Organization
SOUTHERN CANCER CENTER, PC
Active
Organization
SOUTHERN CANCER CENTER, PC
Active
Other names
Southern Cancer Center, PC dba Coastal Pharmacy LLC, Coastal Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN PETTIS (EXECUTIVE DIRECTOR)
(251) 625-6896
Entity
Organization
Contact information
Practice address
29653 ANCHOR CROSS BLVD, SUTIE A 101, DAPHNE, AL 36526-9594
(251) 607-5061
(251) 607-5062
Mailing address
29653 ANCHOR CROSS BLVD STE A101, DAPHNE, AL 36526-9594
(251) 607-5061
(251) 607-5062
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0138455
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/30/2013
Last updated
09/29/2025
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