Healthcare Provider Details

I. General information

NPI: 1093721391
Provider Name (Legal Business Name): DALE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 HOSPITAL AVE
OZARK AL
36360-2018
US

IV. Provider business mailing address

126 HOSPITAL AVE
OZARK AL
36360-2018
US

V. Phone/Fax

Practice location:
  • Phone: 334-774-2601
  • Fax: 334-774-0258
Mailing address:
  • Phone: 334-774-2601
  • Fax: 334-774-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number130019
License Number StateAL

VIII. Authorized Official

Name: CHRISTOPHER STEVENS
Title or Position: PHCY DIR
Credential: RPH
Phone: 334-774-2601