Healthcare Provider Details

I. General information

NPI: 1366875403
Provider Name (Legal Business Name): QUALITY OF LIFE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MARTIN LUTHER KING HWY
TUSKEGEE AL
36083-2138
US

IV. Provider business mailing address

PO BOX 97
GADSDEN AL
35902-0097
US

V. Phone/Fax

Practice location:
  • Phone: 334-727-7341
  • Fax: 334-727-7241
Mailing address:
  • Phone: 256-393-4063
  • Fax: 256-543-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114180
License Number StateAL

VIII. Authorized Official

Name: WAYNE ROWE
Title or Position: CEO
Credential:
Phone: 256-492-0131