Provider Demographics
NPI:1154497071
Name:PROPHARM INC
Entity Type:Organization
Organization Name:PROPHARM INC
Other - Org Name:HEALTHCARE AND IV SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-339-5951
Mailing Address - Street 1:3500 NORTHBROOK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5818
Mailing Address - Country:US
Mailing Address - Phone:205-339-5951
Mailing Address - Fax:205-330-2432
Practice Address - Street 1:3500 NORTHBROOK DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5818
Practice Address - Country:US
Practice Address - Phone:205-339-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0542360001OtherMEDICARE ID NUMBER