Healthcare Provider Details

I. General information

NPI: 1154642304
Provider Name (Legal Business Name): TRUSSVILLE TOTAL CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N CHALKVILLE RD
TRUSSVILLE AL
35173-1376
US

IV. Provider business mailing address

PO BOX 252
CLAY AL
35048-0252
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-3455
  • Fax: 205-655-3425
Mailing address:
  • Phone: 205-655-3455
  • Fax: 205-655-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113409
License Number StateAL

VIII. Authorized Official

Name: GREG CARROLL
Title or Position: OWNER
Credential: R.PH
Phone: 205-680-5557