Healthcare Provider Details

I. General information

NPI: 1528176195
Provider Name (Legal Business Name): CONWELLS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 DAUPHIN ISLAND PKWY
THEODORE AL
36582-7453
US

IV. Provider business mailing address

10835 DAUPHIN ISLAND PKWY
THEODORE AL
36582-7453
US

V. Phone/Fax

Practice location:
  • Phone: 251-973-0805
  • Fax: 251-973-9242
Mailing address:
  • Phone: 251-973-0805
  • Fax: 251-973-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111592
License Number StateAL

VIII. Authorized Official

Name: MR. FRANK C CONWELL
Title or Position: PHARMACIST
Credential:
Phone: 251-973-0805