Healthcare Provider Details

I. General information

NPI: 1356385983
Provider Name (Legal Business Name): SYLACAUGA HEALTH CARE AUTHORITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HICKORY ST
SYLACAUGA AL
35150-2913
US

IV. Provider business mailing address

315 W HICKORY ST
SYLACAUGA AL
35150-2913
US

V. Phone/Fax

Practice location:
  • Phone: 256-401-4065
  • Fax: 256-401-4099
Mailing address:
  • Phone: 256-401-4065
  • Fax: 256-401-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number130008
License Number StateAL

VIII. Authorized Official

Name: GREGORY CRANE
Title or Position: DIRECTOR OF PHARMACY
Credential: BSPHARM
Phone: 256-401-4066