Provider Demographics
NPI:1194846642
Name:MEDTOWN SOUTH
Entity Type:Organization
Organization Name:MEDTOWN SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHRM MANG
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:205-621-1515
Mailing Address - Street 1:1974 CHANDALAR DR
Mailing Address - Street 2:STE B
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4340
Mailing Address - Country:US
Mailing Address - Phone:205-621-1515
Mailing Address - Fax:205-621-7557
Practice Address - Street 1:1974 CHANDALAR DR
Practice Address - Street 2:STE B
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-4340
Practice Address - Country:US
Practice Address - Phone:205-621-1515
Practice Address - Fax:205-621-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0134356OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0134356OtherOTHER ID NUMBER-COMMERCIAL NUMBER