Healthcare Provider Details

I. General information

NPI: 1427167477
Provider Name (Legal Business Name): SOUTHEAST PHARMACEUTICALS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 TROY HWY STE A
ELBA AL
36323-1521
US

IV. Provider business mailing address

PO BOX 415
ELBA AL
36323-0415
US

V. Phone/Fax

Practice location:
  • Phone: 334-897-3746
  • Fax: 334-897-3716
Mailing address:
  • Phone: 334-897-3746
  • Fax: 334-897-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number110474
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number110474
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number110474
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number110474
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number110474
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number110474
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number110474
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number110474
License Number StateAL
# 9
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number110474
License Number StateAL
# 10
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number110474
License Number StateAL
# 11
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number110474
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN NEAL HOLLEY
Title or Position: PRESIDENT
Credential: RPH.
Phone: 334-897-3746