Provider Demographics
NPI:1043687882
Name:DRUID CITY INFUSION
Entity Type:Organization
Organization Name:DRUID CITY INFUSION
Other - Org Name:DRUID CITY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-2363
Mailing Address - Street 1:611 MCFARLAND BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3333
Mailing Address - Country:US
Mailing Address - Phone:205-409-9601
Mailing Address - Fax:205-449-7509
Practice Address - Street 1:611 MCFARLAND BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3333
Practice Address - Country:US
Practice Address - Phone:205-409-9601
Practice Address - Fax:205-449-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy