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General NPI Number Information
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NPI Number | 1003125832
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Entity Type | Organization
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Legal Business Name | PHYSICIAN RX SOURCE
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 118 W MARKET ST
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City | ATHENS
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State | AL
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Zip | 35611-2556
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Country | US
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Telephone | 256-216-1514
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Fax | 256-216-1831
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Provider Business Mailing Address
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Address Line | 118 W MARKET ST
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City | ATHENS
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State | AL
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Zip | 35611-2556
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Country | US
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Telephone | 256-216-1514
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Fax | 256-216-1831
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Authorized Official
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Title or Position | OWNER RPH
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Name | EMILY WILLIAMSON
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Credential |
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Telephone | 256-216-1514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 113428
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License Number State | AL
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