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General NPI Number Information
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NPI Number | 1225476195
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Entity Type | Organization
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Legal Business Name | 4TH AVENUE DRUGS
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 528 4TH AVE N
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City | BESSEMER
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State | AL
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Zip | 35020-6200
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Country | US
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Telephone | 205-834-8505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 381362
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City | BIRMINGHAM
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State | AL
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Zip | 35238-1362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | PAUL C DEICHMANN
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Credential | PHARM D
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Telephone | 205-834-8505
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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 | 114146
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License Number State | AL
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