Provider Demographics
NPI:1487063996
Name:GULF COAST SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:GULF COAST SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CATLIN
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:251-424-1487
Mailing Address - Street 1:110-A EAST AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-424-1487
Mailing Address - Fax:800-638-9321
Practice Address - Street 1:110-A EAST AZALEA AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-424-1487
Practice Address - Fax:800-638-9321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMAISOL SPECIALTY PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL114395333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy