Healthcare Provider Details

I. General information

NPI: 1033319579
Provider Name (Legal Business Name): BUBBAS MEDICINE SHOP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 2ND AVE
OPELIKA AL
36801-4316
US

IV. Provider business mailing address

512 2ND AVE
OPELIKA AL
36801-4316
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-3426
  • Fax: 334-742-0757
Mailing address:
  • Phone: 334-749-3426
  • Fax: 334-742-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MAURY YOUNG
Title or Position: PRESIDENT
Credential:
Phone: 334-749-3426