Organization
SOUTHCOAST MEDICAL GROUP P C
Active
Other names
SouthCoast Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARRERO (PRACTICE ADMINISTRATOR)
(912) 303-3552
Entity
Organization
Contact information
Practice address
1326 EISENHOWER DR BLDG 1, SAVANNAH, GA 31406-3928
(912) 691-3528
(912) 691-3517
Mailing address
PO BOX 16029, SAVANNAH, GA 31416-2729
(912) 691-4100
(912) 691-4289
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PHRE009720
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128560
PK
—
05
—
3000032057A
—
GA
Enumeration date
01/05/2011
Last updated
02/14/2017
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