Provider Demographics
NPI:1275673345
Name:PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:PROFESSIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-221-4564
Mailing Address - Street 1:2001 N AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7068
Mailing Address - Country:US
Mailing Address - Phone:205-221-4564
Mailing Address - Fax:205-221-4555
Practice Address - Street 1:2001 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7068
Practice Address - Country:US
Practice Address - Phone:205-221-4564
Practice Address - Fax:205-221-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4734530001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4734530001Medicare ID - Type Unspecified