Provider Demographics
NPI:1205219789
Name:THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE
Other - Org Name:HUNTSVILLE HOSPITAL MAIL ORDER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-8123
Mailing Address - Street 1:1963 MEMORIAL PKWY SW STE 15
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5035
Mailing Address - Country:US
Mailing Address - Phone:256-265-3900
Mailing Address - Fax:844-213-1898
Practice Address - Street 1:1963 MEMORIAL PKWY SW STE 15
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5035
Practice Address - Country:US
Practice Address - Phone:256-265-3900
Practice Address - Fax:844-213-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6379333600000X
3336C0003X, 3336S0011X
AL1144933336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152811OtherPK