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General NPI Number Information
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NPI Number | 1821392366
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Entity Type | Organization
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Legal Business Name | PHARMACY OF MADISON, LLC
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Dates
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Enumeration Date | 12/24/2010
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Last Update Date | 12/24/2010
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Provider Practice Location Address
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Address Line | 97 HUGHES RD SUITE A
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City | MADISON
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State | AL
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Zip | 35758-3400
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Country | US
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Telephone | 256-227-8467
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Fax | 256-771-0610
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Provider Business Mailing 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 | 205-487-3079
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Fax | 205-487-3138
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Authorized Official
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Title or Position | OWNER
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Name | BRETT JOHNSON SPEEGLE
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Credential |
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Telephone | 256-227-8467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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