Organization
COAST RX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN BOUDREAU PHARMD (MANAGER)
(504) 301-6638
Entity
Organization
Contact information
Practice address
1105 BROAD AVE, GULFPORT, MS 39501-2415
(504) 301-6638
Mailing address
1105 BROAD AVE, GULFPORT, MS 39501-2415
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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