Healthcare Provider Details

I. General information

NPI: 1710992300
Provider Name (Legal Business Name): THE EAST ALABAMA HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 OPELIKA RD
AUBURN AL
36830-4013
US

IV. Provider business mailing address

665 OPELIKA RD
AUBURN AL
36830-4013
US

V. Phone/Fax

Practice location:
  • Phone: 334-821-7843
  • Fax: 334-821-8894
Mailing address:
  • Phone: 334-821-7843
  • Fax: 334-821-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number111272
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL WOOD
Title or Position: PHARMACIST
Credential:
Phone: 334-821-7843