Provider Demographics
NPI:1407870116
Name:PROXSYS RX - ALABAMA, LLC
Entity Type:Organization
Organization Name:PROXSYS RX - ALABAMA, LLC
Other - Org Name:ST. VINCENT'S PHARMACY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-533-9119
Mailing Address - Street 1:1500 URBAN CENTER DR STE 325
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2205
Mailing Address - Country:US
Mailing Address - Phone:205-533-9119
Mailing Address - Fax:
Practice Address - Street 1:50 MEDICAL PARK EAST DRIVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-838-3130
Practice Address - Fax:205-838-3851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROXSYS RX-ALABAMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 3336C0003X
AL1096733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALNCPDPOther0123012
AL100002448Medicaid