Provider Demographics
NPI:1073659322
Name:PAYLESS PHARMACY EXPRESS 1
Entity Type:Organization
Organization Name:PAYLESS PHARMACY EXPRESS 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-351-7006
Mailing Address - Street 1:2122 DANVILLE RD. S.W.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-351-7006
Mailing Address - Fax:256-351-7410
Practice Address - Street 1:2122 DANVILLE RD. S.W.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-351-7006
Practice Address - Fax:256-351-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL107545333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy