Healthcare Provider Details

I. General information

NPI: 1386246262
Provider Name (Legal Business Name): BBMB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607A BOLL WEEVIL CIR
ENTERPRISE AL
36330-2733
US

IV. Provider business mailing address

607A BOLL WEEVIL CIR
ENTERPRISE AL
36330-2733
US

V. Phone/Fax

Practice location:
  • Phone: 334-347-4242
  • Fax:
Mailing address:
  • Phone: 334-347-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACY BOUCHER
Title or Position: OWNER/PHARMACIST
Credential: PHARMD, RPH
Phone: 334-347-4242