MEDICARE: PONQUINETTE INC HUNTS PHARMACY

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	183500000X	Pharmacist	7538	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0563550001	OTHER	AL	MEDICARE ID

Other Identifiers

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

General Provider Information

NPI Number	:	1962540609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONQUINETTE INC HUNTS PHARMACY

Provider Business Mailing Address
First Line	:	2168 SAINT STEPHENS RD
Second Line	:	SUITE B
City	:	MOBILE
State	:	AL
Zip	:	36617-3732
Country	:	US
Telephone Number	:	251-476-4578
Fax Number	:	251-476-1672

Provider Business Practice Location Address
First Line	:	2168 SAINT STEPHENS RD
Second Line	:	SUITE B
City	:	MOBILE
State	:	AL
Zip	:	36617-3732
Country	:	US
Telephone Number	:	251-476-4578
Fax Number	:	251-476-1672

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONALD LEMOYNE PONQUINETTE
Credential	:	RPH
Telephone Number	:	251-476-4578

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/14/2011

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