Provider Demographics
NPI:1003171877
Name:TUSCALOOSA DRUG CAPSTONE LLC
Entity Type:Organization
Organization Name:TUSCALOOSA DRUG CAPSTONE LLC
Other - Org Name:TUSCALOOSA DRUG CAPSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-270-2000
Mailing Address - Street 1:1236 MCFARLAND BLVD NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2206
Mailing Address - Country:US
Mailing Address - Phone:205-469-9669
Mailing Address - Fax:205-469-9414
Practice Address - Street 1:1236 MCFARLAND BLVD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2206
Practice Address - Country:US
Practice Address - Phone:205-469-9669
Practice Address - Fax:205-469-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1139343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135952OtherPK