Healthcare Provider Details

I. General information

NPI: 1568990125
Provider Name (Legal Business Name): HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ROSS CLARK CIR STE 160
DOTHAN AL
36301-3022
US

IV. Provider business mailing address

1108 ROSS CLARK CIR STE 160
DOTHAN AL
36301-3022
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-8116
  • Fax: 334-712-3701
Mailing address:
  • Phone: 334-793-8116
  • Fax: 334-712-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114719
License Number StateAL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOSEPH W DRAKE
Title or Position: OUTPATIENT PHARMACY MANAGER
Credential: PHARMD
Phone: 334-793-8116