Healthcare Provider Details

I. General information

NPI: 1487673778
Provider Name (Legal Business Name): DAUGHTRY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N MAIN ST
OPP AL
36467-1606
US

IV. Provider business mailing address

405 N MAIN ST
OPP AL
36467-1606
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-4541
  • Fax: 334-493-9513
Mailing address:
  • Phone: 334-493-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSANNAH C. DAUGHTRY
Title or Position: OWNER/PHARMACY MANAGER
Credential: R.PH.
Phone: 334-685-2703