Provider Demographics
NPI:1306218367
Name:GARDENDALE HEALTH MART PHARMACY LLC
Entity Type:Organization
Organization Name:GARDENDALE HEALTH MART PHARMACY LLC
Other - Org Name:MILLS PHARMACY AT GARDENDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-427-0955
Mailing Address - Street 1:PO BOX 26679
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35260-0679
Mailing Address - Country:US
Mailing Address - Phone:205-871-9007
Mailing Address - Fax:205-874-9946
Practice Address - Street 1:439 FIELDSTOWN RD STE 145
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3301
Practice Address - Country:US
Practice Address - Phone:205-631-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18122Medicaid