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General NPI Number Information
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NPI Number | 1396715777
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Entity Type | Organization
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Legal Business Name | DEEP SOUTH HOME MEDICAL EQUIPMENT, INC
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 229 SUNRISE LANE
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City | MALVERN
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State | AL
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Zip | 36349
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Country | US
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Telephone | 334-671-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 229 SUNRISE LANE
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City | MALVERN
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State | AL
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Zip | 36349
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Country | US
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Telephone | 334-671-9484
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Fax |
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Authorized Official
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Title or Position | MANAGING OFFICIAL
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Name | RICKY TODD FLOURNOY
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Credential |
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Telephone | 334-671-9484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 065463
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License Number State | AL
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