Provider Demographics
NPI:1487430591
Name:COASTAL FAIRHOPE, LLC
Entity type:Organization
Organization Name:COASTAL FAIRHOPE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SAVANAH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:228-218-3518
Mailing Address - Street 1:19670 GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3840
Mailing Address - Country:US
Mailing Address - Phone:251-929-9959
Mailing Address - Fax:251-929-9958
Practice Address - Street 1:19670 GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3840
Practice Address - Country:US
Practice Address - Phone:251-929-9959
Practice Address - Fax:251-929-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy