Provider Demographics
NPI:1497219034
Name:MODEL PHARMACEUTICALS
Entity Type:Organization
Organization Name:MODEL PHARMACEUTICALS
Other - Org Name:TOWN CENTER PHARMACY A SOUTHERN RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-789-4507
Mailing Address - Street 1:2415 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2020
Mailing Address - Country:US
Mailing Address - Phone:228-400-4270
Mailing Address - Fax:800-651-3566
Practice Address - Street 1:171 TOWN CENTER DR # DRIVE-3
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4102
Practice Address - Country:US
Practice Address - Phone:256-676-6688
Practice Address - Fax:256-676-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy