Provider Demographics
NPI:1497242580
Name:FLORALA PHARMACY INC
Entity Type:Organization
Organization Name:FLORALA PHARMACY INC
Other - Org Name:PHARMACARE EVERGREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:251-578-2273
Mailing Address - Street 1:23355 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-3818
Mailing Address - Country:US
Mailing Address - Phone:334-858-3291
Mailing Address - Fax:334-858-5254
Practice Address - Street 1:451 W FRONT ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3280
Practice Address - Country:US
Practice Address - Phone:251-578-2273
Practice Address - Fax:251-578-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1147903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176706OtherPK
AL215095Medicaid