Healthcare Provider Details

I. General information

NPI: 1497219034
Provider Name (Legal Business Name): MODEL PHARMACEUTICALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR # DRIVE-3
ANNISTON AL
36205-4102
US

IV. Provider business mailing address

2415 14TH ST
GULFPORT MS
39501-2020
US

V. Phone/Fax

Practice location:
  • Phone: 256-676-6688
  • Fax: 256-676-6685
Mailing address:
  • Phone: 228-400-4270
  • Fax: 800-651-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EMILY ELLIOTT
Title or Position: DIRECTOR
Credential:
Phone: 205-789-4507