Provider Demographics
NPI:1902449721
Name:COATS PHARMACY INC
Entity Type:Organization
Organization Name:COATS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-8500
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0811
Mailing Address - Country:US
Mailing Address - Phone:910-897-8500
Mailing Address - Fax:910-897-5114
Practice Address - Street 1:393 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521-8132
Practice Address - Country:US
Practice Address - Phone:910-897-8500
Practice Address - Fax:910-897-5114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COATS PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435206Medicaid