Healthcare Provider Details

I. General information

NPI: 1194730705
Provider Name (Legal Business Name): LINEVILLE CLINIC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 HIGHWAY 431 STE B
ROANOKE AL
36274-1430
US

IV. Provider business mailing address

PO BOX 248
ROANOKE AL
36274-0248
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-6337
  • Fax: 334-863-6339
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114138
License Number StateAL

VIII. Authorized Official

Name: MARK LOWRY
Title or Position: OWNER
Credential: PHRM
Phone: 334-863-6337