Organization
GULF COAST PHARMACY LLC
Active
Other names
Gulf Coast Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BUSH (PHARMACIST)
(251) 404-3343
Entity
Organization
Contact information
Practice address
515 AZALEA RD, MOBILE, AL 36609-1501
(251) 342-5519
Mailing address
515 AZALEA RD, MOBILE, AL 36609-1501
(251) 342-5519
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
113142
AL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336N0007X
Nuclear Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0137162
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/19/2011
Last updated
09/27/2011
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