Healthcare Provider Details

I. General information

NPI: 1225056567
Provider Name (Legal Business Name): FRED C SANDLIN JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 MILITARY ST S
HAMILTON AL
35570-4737
US

IV. Provider business mailing address

PO BOX 36
HAMILTON AL
35570-0036
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-3193
  • Fax: 205-921-2576
Mailing address:
  • Phone: 205-921-3193
  • Fax: 205-921-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number104160
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number104160
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number104160
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number104160
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number104160
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number104160
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number104160
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number104160
License Number StateAL
# 9
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number104160
License Number StateAL
# 10
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number104160
License Number StateAL

VIII. Authorized Official

Name: FRED C SANDLIN JR.
Title or Position: OWNER
Credential: RHP
Phone: 205-921-3193