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General NPI Number Information
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NPI Number | 1114191459
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Entity Type | Organization
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Legal Business Name | FAYETTE PHARMACY INC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1128 2ND AVE NE
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City | FAYETTE
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State | AL
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Zip | 35555-1739
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Country | US
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Telephone | 205-932-5400
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Fax | 205-932-5401
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Provider Business Mailing Address
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Address Line | 1128 2ND AVE NE
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City | FAYETTE
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State | AL
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Zip | 35555-1739
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Country | US
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Telephone | 205-932-5400
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Fax | 205-932-5401
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Authorized Official
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Title or Position | PHRMD
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Name | SUMMER WILSON
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Credential |
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Telephone | 205-712-1685
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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 | 113087
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License Number State | AL
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