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General NPI Number Information
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NPI Number | 1841532546
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Entity Type | Organization
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Legal Business Name | PRICEVILLE PHARMACY LLC
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 2941 POINT MALLARD PKWY SUITE A
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City | DECATUR
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State | AL
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Zip | 35603
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Country | US
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Telephone | 256-350-2588
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Fax | 256-350-9860
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Provider Business Mailing Address
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Address Line | 2941 POINT MALLARD PKWY SUITE A
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City | DECATUR
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State | AL
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Zip | 35603
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Country | US
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Telephone | 256-350-2588
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Fax | 256-350-9860
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | DR. AUNDRIA BALDWIN
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Credential | PHARM D
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Telephone | 256-350-2588
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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 | 114056
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License Number State | AL
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