=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023512829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SRX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 11/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 S ROYAL ST
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36602-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-277-8990
-----------------------------------------------------
Fax | 251-517-4441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 S ROYAL ST
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36602-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-277-8990
-----------------------------------------------------
Fax | 251-517-4441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHARMACIST
-----------------------------------------------------
Name | KELLY H STINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-277-8990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 114788
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------