Healthcare Provider Details

I. General information

NPI: 1104856459
Provider Name (Legal Business Name): TENNESSEE VALLEY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13574 HIGHWAY 231 431 N STE B
HAZEL GREEN AL
35750-8642
US

IV. Provider business mailing address

13574 HIGHWAY 231 431 N STE B
HAZEL GREEN AL
35750-8642
US

V. Phone/Fax

Practice location:
  • Phone: 256-813-0150
  • Fax: 256-813-0149
Mailing address:
  • Phone: 256-813-0150
  • Fax: 256-813-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112435
License Number StateAL

VIII. Authorized Official

Name: MR. CHANDLER THOMAS WILLINGHAM
Title or Position: CO-OWNER/PHARMACIST
Credential: RPH
Phone: 256-813-0150