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General NPI Number Information
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NPI Number | 1194846642
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Entity Type | Organization
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Legal Business Name | MEDTOWN SOUTH
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 1974 CHANDALAR DR STE B
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City | PELHAM
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State | AL
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Zip | 35124-4340
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Country | US
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Telephone | 205-621-1515
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Fax | 205-621-7557
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Provider Business Mailing Address
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Address Line | 1974 CHANDALAR DR STE B
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City | PELHAM
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State | AL
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Zip | 35124-4340
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Country | US
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Telephone | 205-621-1515
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Fax | 205-621-7557
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Authorized Official
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Title or Position | PHRM MANG
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Name | CHRIS SIMPSON
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Credential | PHRMD
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Telephone | 205-621-1515
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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 |
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License Number State |
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