Provider Demographics
NPI:1699541516
Name:COASTAL THERAPEUTICS, INC
Entity type:Organization
Organization Name:COASTAL THERAPEUTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-633-6235
Mailing Address - Street 1:2225 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2319
Mailing Address - Country:US
Mailing Address - Phone:251-943-0394
Mailing Address - Fax:
Practice Address - Street 1:2225 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2319
Practice Address - Country:US
Practice Address - Phone:251-943-0394
Practice Address - Fax:251-650-1562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL THERAPEUTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-01
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies