Healthcare Provider Details

I. General information

NPI: 1659669976
Provider Name (Legal Business Name): INJURY MED EXPRESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 US HIGHWAY 98 UNIT H
DAPHNE AL
36526-5110
US

IV. Provider business mailing address

1410 US HIGHWAY 98 UNIT H
DAPHNE AL
36526-5110
US

V. Phone/Fax

Practice location:
  • Phone: 888-418-9808
  • Fax: 888-484-5016
Mailing address:
  • Phone: 888-418-9808
  • Fax: 888-484-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberNP000017
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number113782
License Number StateAL

VIII. Authorized Official

Name: ASHLEY HAMMOND
Title or Position: MANAGING CONSULTANT
Credential:
Phone: 866-832-2263