Provider Demographics
NPI:1205830999
Name:ORANGE BEACH FAMILY PHARMACY
Entity Type:Organization
Organization Name:ORANGE BEACH FAMILY PHARMACY
Other - Org Name:FAMILY PHARMACY OF ORANGE BEACH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTISUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRANZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CDE
Authorized Official - Phone:251-981-2255
Mailing Address - Street 1:25299 A CANAL ROAD #6
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561
Mailing Address - Country:US
Mailing Address - Phone:251-981-2255
Mailing Address - Fax:251-981-2282
Practice Address - Street 1:25299 A CANAL ROAD #6
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561
Practice Address - Country:US
Practice Address - Phone:251-981-2255
Practice Address - Fax:251-981-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110764332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1130330001Medicare ID - Type Unspecified