Healthcare Provider Details

I. General information

NPI: 1801936943
Provider Name (Legal Business Name): RX EXPRESS PHARMACY OF BAYOU LA BATRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13286 N WINTZELL AVE
BAYOU LA BATRE AL
36509-2146
US

IV. Provider business mailing address

13286 N WINTZELL AVE
BAYOU LA BATRE AL
36509-2146
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-7455
  • Fax: 251-824-7450
Mailing address:
  • Phone: 251-824-7455
  • Fax: 251-824-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAL

VIII. Authorized Official

Name: DR. HARRY LLOYD HOLSTON JR.
Title or Position: PHARMACIST, PRESIDENT
Credential: PHARMD
Phone: 251-824-7455