Healthcare Provider Details

I. General information

NPI: 1386659993
Provider Name (Legal Business Name): MC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BRUNSON ST
ENTERPRISE AL
36330-1922
US

IV. Provider business mailing address

PO BOX 311688
ENTERPRISE AL
36331-1688
US

V. Phone/Fax

Practice location:
  • Phone: 334-347-6865
  • Fax: 334-393-0679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number106520
License Number StateAL

VII. Legacy identifiers

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

# 1
Identifier100000272
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier0106256
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: PAUL RUSSELL
Title or Position: OWNER
Credential: RPH
Phone: 334-347-6865