Healthcare Provider Details

I. General information

NPI: 1952952871
Provider Name (Legal Business Name): SCPG ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 2ND AVE NE
FAYETTE AL
35555-1739
US

IV. Provider business mailing address

PO BOX 7791
LITTLE ROCK AR
72217-7791
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-5400
  • Fax: 205-932-5401
Mailing address:
  • Phone: 918-640-9270
  • 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: GALEN PERKINS
Title or Position: MEMBER
Credential:
Phone: 501-258-4399