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General NPI Number Information
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NPI Number | 1699372771
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Entity Type | Organization
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Legal Business Name | MEDICINE SHOPPE 0804 INC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 2006 DANVILLE RD SW STE C
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City | DECATUR
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State | AL
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Zip | 35601-4640
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Country | US
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Telephone | 256-350-3338
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Fax | 256-350-9829
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Provider Business Mailing Address
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Address Line | 2006 DANVILLE RD SW STE C
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City | DECATUR
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State | AL
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Zip | 35601-4640
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Country | US
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Telephone | 256-350-3338
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Fax | 256-350-9829
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN PRITCHARD
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Credential | PHARMACIST
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Telephone | 256-350-3338
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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 |
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