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NPI Code Detail

MEDICARE: SYLACAUGA HEALTH CARE AUTHORITY INC

MEDICARE: SYLACAUGA HEALTH CARE AUTHORITY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy
33336M0003XManaged Care Organization Pharmacy
43336I0012XInstitutional Pharmacy130008AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11989675OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356385983
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYLACAUGA HEALTH CARE AUTHORITY INC
Provider Business Mailing Address
First Line : 315 W HICKORY ST
Second Line :
City : SYLACAUGA
State : AL
Zip : 35150-2913
Country : US
Telephone Number : 256-401-4065
Fax Number : 256-401-4099
Provider Business Practice Location Address
First Line : 315 W HICKORY ST
Second Line :
City : SYLACAUGA
State : AL
Zip : 35150-2913
Country : US
Telephone Number : 256-401-4065
Fax Number : 256-401-4099
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : GREGORY CRANE
Credential : BSPHARM
Telephone Number : 256-401-4066
Provider Enumeration Date : 06/15/2006
Last Update Date : 02/21/2017

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Directions to “SYLACAUGA HEALTH CARE AUTHORITY INC ” Practice Location

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