Healthcare Provider Details

I. General information

NPI: 1144251943
Provider Name (Legal Business Name): DURA MED SOUTHEAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 HIGHWAY 113
FLOMATON AL
36441-4556
US

IV. Provider business mailing address

174 HIGHWAY 113 PO BOX 1018
FLOMATON AL
36441-4556
US

V. Phone/Fax

Practice location:
  • Phone: 251-296-4224
  • Fax: 251-296-4226
Mailing address:
  • Phone: 251-296-4224
  • Fax: 251-296-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111970
License Number StateAL

VIII. Authorized Official

Name: MISTY BLACKMAN
Title or Position: SUPERVISING PHARMACIST
Credential: RPH
Phone: 251-296-4224