Provider Demographics
NPI:1548701121
Name:MIDTOWN PHARMACY LLC
Entity type:Organization
Organization Name:MIDTOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZERTZIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-316-2031
Mailing Address - Street 1:278 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-3201
Mailing Address - Country:US
Mailing Address - Phone:256-543-7777
Mailing Address - Fax:256-546-1222
Practice Address - Street 1:278 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3201
Practice Address - Country:US
Practice Address - Phone:606-316-2031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy