Organization
COASTAL COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Coastal Community Pharmacy #102
Organization subpart
No
Provider details
NPI number
Authorized official
KAVANAUGH CHANDLER MD (CEO)
(912) 275-8028
Entity
Organization
Contact information
Practice address
2321 POOLER PKWY STE 107, POOLER, GA 31322-4423
(912) 333-8255
Mailing address
100 PROFESSIONAL CENTER DR, BRUNSWICK, GA 31525-6743
(912) 574-5075
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
08/21/2024
Last updated
01/29/2025
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