Healthcare Provider Details

I. General information

NPI: 1811548746
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: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 MILITARY ST S
HAMILTON AL
35570-5006
US

IV. Provider business mailing address

PO BOX 34407 PMB 53760
LITTLE ROCK AR
72203-4407
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-7465
  • Fax: 205-921-7896
Mailing address:
  • Phone: 918-640-9270
  • Fax: 205-921-1220

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: UMAR FAROOQ
Title or Position: PRESIDENT
Credential:
Phone: 501-392-8680