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General NPI Number Information
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NPI Number | 1770839771
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Entity Type | Organization
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Legal Business Name | TRIAD RX, INC.
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 26258 POLLARD RD
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City | DAPHNE
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State | AL
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Zip | 36526-4250
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Country | US
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Telephone | 251-380-7630
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Fax | 251-380-7631
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Provider Business Mailing Address
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Address Line | PO BOX 1530
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City | DAPHNE
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State | AL
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Zip | 36526-1530
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Country | US
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Telephone | 251-380-7630
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Fax | 251-380-7631
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | ROBERT ROBERTS
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Credential |
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Telephone | 251-380-7630
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 113869
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License Number State | AL
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