Healthcare Provider Details

I. General information

NPI: 1750765137
Provider Name (Legal Business Name): SMITHS STATION PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 LEE ROAD 430
SMITHS STATION AL
36877-2571
US

IV. Provider business mailing address

2828 LEE ROAD 430
SMITHS STATION AL
36877-2571
US

V. Phone/Fax

Practice location:
  • Phone: 334-408-6106
  • Fax: 334-408-6108
Mailing address:
  • Phone: 334-408-6106
  • Fax: 334-408-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114499
License Number StateAL

VIII. Authorized Official

Name: AMIE FLOURNOY
Title or Position: OWNER/PIC/AO
Credential:
Phone: 706-573-6106