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Organization

SOUTHERN CANCER CENTER, PC

Active
Other names
Southern Cancer Center, PC dba Coastal Pharmacy LLC, Coastal Pharmacy LLC
Organization subpart
No

Provider details

NPI number
Authorized official
LAUREN PETTIS (EXECUTIVE DIRECTOR)
(251) 625-6896
Entity
Organization

Contact information

Practice address
29653 ANCHOR CROSS BLVD, SUTIE A 101, DAPHNE, AL 36526-9594
(251) 607-5061
(251) 607-5062
Mailing address
29653 ANCHOR CROSS BLVD STE A101, DAPHNE, AL 36526-9594
(251) 607-5061
(251) 607-5062

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
3336C0003X
Community/Retail Pharmacy
3336S0011X
Specialty Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0138455
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
01/30/2013
Last updated
09/29/2025
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