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General NPI Number Information
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NPI Number | 1740225184
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Entity Type | Organization
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Legal Business Name | PHARMACY MANAGEMENT GROUP
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 186 MEDICAL DR
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City | WINFIELD
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State | AL
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Zip | 35594-5002
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Country | US
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Telephone | 205-487-6428
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Fax | 205-487-4515
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Provider Business Mailing Address
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Address Line | 101 12TH ST S
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City | COLUMBUS
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State | MS
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Zip | 39701-5830
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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 | COE MANG MEMBER
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Name | RON HARRIS
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Credential |
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Telephone | 662-327-4025
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 111792
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License Number State | AL
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