Healthcare Provider Details

I. General information

NPI: 1922472026
Provider Name (Legal Business Name): FAF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 MEMORIAL PKWY SW STE L
HUNTSVILLE AL
35802-4364
US

IV. Provider business mailing address

4040 MEMORIAL PKWY SW STE L
HUNTSVILLE AL
35802-4364
US

V. Phone/Fax

Practice location:
  • Phone: 256-705-6499
  • Fax: 256-705-6497
Mailing address:
  • Phone: 256-705-6499
  • Fax: 256-705-6497

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 Number114561
License Number StateAL

VIII. Authorized Official

Name: ASHLEY WATSON
Title or Position: PHCY MANGER/AO
Credential:
Phone: 256-705-6499