Basic Information
| Provider Information | |||||||||
| NPI: | 1942741491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COASTAL PHARMACEUTICA SERVICES CORP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HERBAY PHARMACY NORTH/INFUSIONRX | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1451 N RICE AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930307926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059812500 | ||||||||
| FaxNumber: | 8059818447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1451 N RICE AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930307926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059812500 | ||||||||
| FaxNumber: | 8059818447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2017 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARRY | ||||||||
| AuthorizedOfficialFirstName: | MAY | ||||||||
| AuthorizedOfficialMiddleName: | KUO | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8059812500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHARMERICA CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHARMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336H0001X | PHA45445 | CA | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
No ID Information.