Healthcare Provider Details

I. General information

NPI: 1538285499
Provider Name (Legal Business Name): MEDICAL ARTS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 FORTNER ST
DOTHAN AL
36301-2405
US

IV. Provider business mailing address

219 FORTNER ST
DOTHAN AL
36301-2405
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-4191
  • Fax: 334-793-5742
Mailing address:
  • Phone: 334-794-4191
  • Fax: 334-793-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number110705
License Number StateAL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. LARRY LAMONT BOND
Title or Position: PRESIDENT
Credential:
Phone: 334-794-4191