Provider Demographics
NPI:1164575692
Name:ACIPCO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ACIPCO MEDICAL GROUP INC
Other - Org Name:ACIPCO MEDICAL GROUP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CURREN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-325-8081
Mailing Address - Street 1:PO BOX 12725
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-6725
Mailing Address - Country:US
Mailing Address - Phone:205-325-8081
Mailing Address - Fax:205-307-2719
Practice Address - Street 1:3200 16TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4202
Practice Address - Country:US
Practice Address - Phone:205-325-7012
Practice Address - Fax:205-307-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1127433336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002930Medicaid
1988510OtherPK
AL100002930Medicaid