Provider Demographics
NPI:1316358344
Name:RX PRO OF ALABAMA LLC
Entity Type:Organization
Organization Name:RX PRO OF ALABAMA LLC
Other - Org Name:RX PRO OF ALABAMA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-446-0460
Mailing Address - Street 1:2355 HARTFORD HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4923
Mailing Address - Country:US
Mailing Address - Phone:601-326-5378
Mailing Address - Fax:601-326-5381
Practice Address - Street 1:2355 HARTFORD HWY STE 6
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4923
Practice Address - Country:US
Practice Address - Phone:601-326-5378
Practice Address - Fax:601-326-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AL1143473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146084OtherPK