Healthcare Provider Details

I. General information

NPI: 1497872782
Provider Name (Legal Business Name): ERNIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 C HWY 17
HELENA AL
35080
US

IV. Provider business mailing address

5135 C HWY 17
HELENA AL
35080
US

V. Phone/Fax

Practice location:
  • Phone: 205-663-6270
  • Fax: 205-663-2609
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111874
License Number StateAL

VIII. Authorized Official

Name: ERNEST KOCHEM
Title or Position: OWNER
Credential: RPH
Phone: 205-663-6270