Healthcare Provider Details

I. General information

NPI: 1215089305
Provider Name (Legal Business Name): THE EAST ALABAMA HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PEPPERELL PKWY STE 292 SUITE 292
OPELIKA AL
36801-5452
US

IV. Provider business mailing address

2000 PEPPERELL PKWY STE 292
OPELIKA AL
36801-5452
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-2293
  • Fax: 334-528-4702
Mailing address:
  • Phone: 334-528-2293
  • Fax: 334-528-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHNR001136
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114653
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL A PRICE JR.
Title or Position: CFO
Credential:
Phone: 334-528-1310