Provider Demographics
NPI:1346434537
Name:HARPERSVILLE PHARMACY
Entity Type:Organization
Organization Name:HARPERSVILLE PHARMACY
Other - Org Name:HARPERSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:205-642-9300
Mailing Address - Street 1:39321 HIGHWAY 25
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARPERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35078-4949
Mailing Address - Country:US
Mailing Address - Phone:205-642-9222
Mailing Address - Fax:205-642-9224
Practice Address - Street 1:39321 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:HARPERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35078-4949
Practice Address - Country:US
Practice Address - Phone:205-642-9222
Practice Address - Fax:205-642-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1129823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10039185Medicaid
1996167OtherPK