# COASTAL DIABETES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730494451
- **Authorized official:** MR. ANTHONY ROWLAND (PRESIDENT)
- **Authorized official phone:** (850) 243-0483

## Contact information

- **Practice address:** 12 MIRACLE STRIP PKWY SE, SUITE 102, FORT WALTON BEACH, FL 32548-5814
- **Practice address phone:** (850) 243-0483
- **Practice address fax:** (850) 243-1421
- **Mailing address:** PO BOX 242037, MONTGOMERY, AL 36124-2037
- **Mailing address phone:** (334) 396-3273
- **Mailing address fax:** (334) 396-4905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 08/18/2010
- **Last updated:** 08/18/2010