Healthcare Provider Details

I. General information

NPI: 1043366800
Provider Name (Legal Business Name): FYFFE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BLACKWELL ST.
FYFFE AL
35971-0067
US

IV. Provider business mailing address

PO BOX 67
FYFFE AL
35971-0067
US

V. Phone/Fax

Practice location:
  • Phone: 256-623-2944
  • Fax: 256-623-3938
Mailing address:
  • Phone: 256-623-2944
  • Fax: 256-623-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number104223
License Number StateAL

VIII. Authorized Official

Name: MR. BRANDON L. RAINS
Title or Position: OWNER
Credential:
Phone: 256-623-2944