Provider Demographics
NPI:1568350767
Name:CROWN COAST PHARMACY LLC
Entity type:Organization
Organization Name:CROWN COAST PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-960-2689
Mailing Address - Street 1:11322 PEPPERVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3769
Mailing Address - Country:US
Mailing Address - Phone:760-960-2689
Mailing Address - Fax:
Practice Address - Street 1:171 C AVE STE A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1423
Practice Address - Country:US
Practice Address - Phone:760-960-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy