Healthcare Provider Details

I. General information

NPI: 1154693737
Provider Name (Legal Business Name): DOUBLE OAK MOUNTAIN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 HIGHWAY 280 STE 123
BIRMINGHAM AL
35242-6582
US

IV. Provider business mailing address

5510 HIGHWAY 280 STE 123
BIRMINGHAM AL
35242-6582
US

V. Phone/Fax

Practice location:
  • Phone: 205-991-0800
  • Fax: 205-991-0810
Mailing address:
  • Phone: 205-991-0800
  • Fax: 205-991-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113854
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH FEICK
Title or Position: OWNER/TCH/AO
Credential: RPH
Phone: 205-991-0800