Provider Demographics
NPI: | 1174820294 |
---|---|
Name: | FAMILY PHARMACY INC |
Entity type: | Organization |
Organization Name: | FAMILY PHARMACY INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PHARMACIST/OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHRISTOPHER |
Authorized Official - Middle Name: | CLAY |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 256-831-6116 |
Mailing Address - Street 1: | 610 QUINTARD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | OXFORD |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36203-1840 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 256-831-6116 |
Mailing Address - Fax: | 866-833-7553 |
Practice Address - Street 1: | 1801 QUINTARD AVE |
Practice Address - Street 2: | |
Practice Address - City: | ANNISTON |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36201-3852 |
Practice Address - Country: | US |
Practice Address - Phone: | 256-403-0500 |
Practice Address - Fax: | 866-912-6586 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-25 |
Last Update Date: | 2015-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 6619810003 | Medicare NSC |