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General NPI Number Information
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NPI Number | 1629160841
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Entity Type | Organization
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Legal Business Name | MEDICAL PARK PHARMACY INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1623 21ST CT
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City | PHENIX CITY
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State | AL
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Zip | 36867
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Country | US
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Telephone | 334-298-4010
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Fax | 334-298-0342
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Provider Business Mailing Address
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Address Line | 1623 21ST CT
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City | PHENIX CITY
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State | AL
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Zip | 36867
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Country | US
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Telephone | 334-298-4010
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Fax | 334-298-0342
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Authorized Official
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Title or Position | PRES
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Name | MR. NORMAN WILLARD DAVIS
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Credential | RPH
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Telephone | 334-298-4010
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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 | 106743
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License Number State | AL
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