1265583256 NPI number — REDMONT PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265583256 NPI number — REDMONT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDMONT PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REDMONT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265583256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BAY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35582-1487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-356-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 4TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BAY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35582-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-356-9000
Provider Business Practice Location Address Fax Number:
256-356-9060
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEEKS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT/PIC/AO
Authorized Official Telephone Number:
256-356-9000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  14425/7.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 108330 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00030214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009919100 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1990901 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100001897 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040386 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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