Provider Demographics
NPI:1114096062
Name:DALE PHARMACY INC
Entity Type:Organization
Organization Name:DALE PHARMACY INC
Other - Org Name:DALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-774-2808
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-1185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1548 S US HIGHWAY 231
Practice Address - Street 2:SUITE A 6
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-4515
Practice Address - Country:US
Practice Address - Phone:334-774-7979
Practice Address - Fax:334-445-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0134178OtherOTHER ID NUMBER-COMMERCIAL NUMBER