Organization
COASTAL PHARMACY LLC
Active
Other names
COASTAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FLORA MARIE WADE (MANAGING MEMBER)
(442) 257-2151
Entity
Organization
Contact information
Practice address
940 E VALLEY PKWY STE K, ESCONDIDO, CA 92025-3441
(442) 257-2151
Mailing address
940 E VALLEY PKWY STE K, ESCONDIDO, CA 92025-3441
(442) 257-2151
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY59344
BOARD OF PHARMACY
CA
Enumeration date
02/10/2025
Last updated
02/10/2025
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