Healthcare Provider Details

I. General information

NPI: 1245529494
Provider Name (Legal Business Name): C & R PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4682 AIRPORT BLVD STE A
MOBILE AL
36608-3124
US

IV. Provider business mailing address

4682 AIRPORT BLVD STE A
MOBILE AL
36608-3124
US

V. Phone/Fax

Practice location:
  • Phone: 251-341-1113
  • Fax: 241-341-1116
Mailing address:
  • Phone: 251-341-1113
  • Fax: 251-341-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113578
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: XIULU RUAN
Title or Position: CO-OWNER
Credential:
Phone: 251-478-4900