Provider Demographics
NPI:1407223720
Name:PEPPERTOWN USA, LLC
Entity Type:Organization
Organization Name:PEPPERTOWN USA, LLC
Other - Org Name:THERAQUATICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELECTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-669-8838
Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36102-1414
Mailing Address - Country:US
Mailing Address - Phone:334-669-8838
Mailing Address - Fax:
Practice Address - Street 1:704 N PERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-2442
Practice Address - Country:US
Practice Address - Phone:334-669-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR006584441332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies