Organization
COASTAL PHARMACY LABS LLC
Active
Other names
Coastal Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AL DIXON (OWNER)
(912) 756-3331
Entity
Organization
Contact information
Practice address
6709 FOREST PARK DR STE A, SAVANNAH, GA 31406-2587
(912) 354-5188
(912) 355-3685
Mailing address
6709 FOREST PARK DR STE A, SAVANNAH, GA 31406-2587
(912) 354-5188
(912) 355-3685
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PHRE009634
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141985
PK
—
Enumeration date
07/21/2008
Last updated
09/23/2013
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