Healthcare Provider Details

I. General information

NPI: 1750471835
Provider Name (Legal Business Name): STAVROS L LADAS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S CRAFT HWY
CHICKASAW AL
36611-2213
US

IV. Provider business mailing address

426 S CRAFT HWY
CHICKASAW AL
36611-2213
US

V. Phone/Fax

Practice location:
  • Phone: 251-456-4172
  • Fax: 251-456-4175
Mailing address:
  • Phone: 251-456-4172
  • Fax: 251-456-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number106746
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: