# GULFCOAST PHARMACEUTICAL SPECIALTY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GPS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902911936
- **Authorized official:** MYRA BLACK (OWNER)
- **Authorized official phone:** (225) 647-4182

## Contact information

- **Practice address:** 1039 E HIGHWAY 30, GONZALES, LA 70737-4757
- **Practice address phone:** (225) 647-4182
- **Practice address fax:** (225) 644-0460
- **Mailing address:** PO BOX 489, GONZALES, LA 70707-0489
- **Mailing address phone:** (225) 647-4182
- **Mailing address fax:** (225) 644-0460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | — | — |
| 3336I0012X | Institutional Pharmacy | 005084IR | LA | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | — | — |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 01/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1270784 | — | LA |
| 01 | — | 1929972 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |