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General NPI Number Information
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NPI Number | 1417435876
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Entity Type | Organization
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Legal Business Name | 1ST STREET PHARMACY, LLC
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 1070 1ST ST NW
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City | CHILDERSBURG
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State | AL
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Zip | 35044-1269
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Country | US
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Telephone | 256-346-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 764
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City | PELL CITY
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State | AL
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Zip | 35125-0764
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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 | PHARMACY MANAGER
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Name | JENNIFER STAMPS
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Credential | PHARM.D.
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Telephone | 256-346-3500
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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 |
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License Number State | AL
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