Healthcare Provider Details

I. General information

NPI: 1104359041
Provider Name (Legal Business Name): DOTHAN RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 HEALTHWEST DR
DOTHAN AL
36303-2031
US

IV. Provider business mailing address

287 HEALTHWEST DR
DOTHAN AL
36303-2031
US

V. Phone/Fax

Practice location:
  • Phone: 334-305-0055
  • Fax: 334-305-0056
Mailing address:
  • Phone: 334-305-0055
  • Fax: 334-305-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number114703
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORI KIRKLAND
Title or Position: PHARM.D.
Credential: PHARM.D.
Phone: 334-305-0055