Provider Demographics
NPI:1093029530
Name:MONROVIA PHARMACY LLC
Entity Type:Organization
Organization Name:MONROVIA PHARMACY LLC
Other - Org Name:MONROVIA PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-585-9200
Mailing Address - Street 1:1878 JEFF RD NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4260
Mailing Address - Country:US
Mailing Address - Phone:256-489-7626
Mailing Address - Fax:
Practice Address - Street 1:1878 JEFF RD NW STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4261
Practice Address - Country:US
Practice Address - Phone:256-489-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1134123336C0003X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136730OtherNCPDP PROVIDER IDENTIFICATION NUMBER