Healthcare Provider Details

I. General information

NPI: 1043862931
Provider Name (Legal Business Name): PHARMACY CENTER SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 ROSS CLARK CIRCLE SUITE 103
DOTHAN AL
36301
US

IV. Provider business mailing address

1971 S BRANNON STAND RD STE 1
DOTHAN AL
36305-6985
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-5300
  • Fax:
Mailing address:
  • Phone: 334-446-5300
  • Fax: 334-446-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN TAYLOR
Title or Position: OWNER
Credential: PHARMD
Phone: 334-446-5300