Provider Demographics
NPI:1346239795
Name:SENIOR CARE PHARMACY INC
Entity Type:Organization
Organization Name:SENIOR CARE PHARMACY INC
Other - Org Name:SENIOR CARE PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM E DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-391-3636
Mailing Address - Street 1:4373 NORTHCREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2171
Mailing Address - Country:US
Mailing Address - Phone:205-391-3636
Mailing Address - Fax:866-680-7046
Practice Address - Street 1:4373 NORTHCREEK BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-2171
Practice Address - Country:US
Practice Address - Phone:205-391-3636
Practice Address - Fax:866-680-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1131513336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1990860OtherPK
AL100001796Medicaid