Provider Demographics
NPI:1003850785
Name:ASHLAND PHARMACY, INC.
Entity Type:Organization
Organization Name:ASHLAND PHARMACY, INC.
Other - Org Name:ASHLAND PHARMACY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:BOOKKEEPER
Authorized Official - Phone:256-354-2166
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-0487
Mailing Address - Country:US
Mailing Address - Phone:256-354-2166
Mailing Address - Fax:256-354-2168
Practice Address - Street 1:83074 HIGHWAY 9
Practice Address - Street 2:83074 HWY 9
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-7975
Practice Address - Country:US
Practice Address - Phone:256-354-2166
Practice Address - Fax:256-354-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1012403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050670Medicaid
AL100000278Medicaid
2121703OtherPK
0405000001Medicare NSC