Provider Demographics
NPI:1275742546
Name:POARCH CREEK HEALTH CLINIC PHARMACY
Entity Type:Organization
Organization Name:POARCH CREEK HEALTH CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-368-8630
Mailing Address - Street 1:5811 JACK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-5025
Mailing Address - Country:US
Mailing Address - Phone:251-368-8630
Mailing Address - Fax:251-368-0832
Practice Address - Street 1:5811 JACK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-5025
Practice Address - Country:US
Practice Address - Phone:251-368-8630
Practice Address - Fax:251-368-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0130574OtherNCPDP NUMBER
BP1332080OtherPHARMACY DEA