Healthcare Provider Details

I. General information

NPI: 1558598458
Provider Name (Legal Business Name): PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101A VILLA DR
DAPHNE AL
36526-4653
US

IV. Provider business mailing address

101A VILLA DR
DAPHNE AL
36526-4653
US

V. Phone/Fax

Practice location:
  • Phone: 251-621-0433
  • Fax: 251-621-0434
Mailing address:
  • Phone: 251-621-0433
  • Fax: 251-621-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number113275
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0136069
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: DENNIS GADDY
Title or Position: PRESIDENT
Credential:
Phone: 251-621-0433