Provider Demographics
NPI:1508169277
Name:D.W. MCMILLAN MEMORIAL HOSPITAL / ESCAMBIA COUNTY HEALTH AUTHORITY
Entity Type:Organization
Organization Name:D.W. MCMILLAN MEMORIAL HOSPITAL / ESCAMBIA COUNTY HEALTH AUTHORITY
Other - Org Name:D.W. MCMILLAN MEMORIAL HOSPITAL / ESCAMBIA COUNTY HEALTH AUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-809-8390
Mailing Address - Street 1:1301 BELLEVILLE AVE
Mailing Address - Street 2:P.O. DRAWER 908
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1306
Mailing Address - Country:US
Mailing Address - Phone:251-809-8390
Mailing Address - Fax:
Practice Address - Street 1:1301 BELLEVILLE AVE
Practice Address - Street 2:P O DRAWER 908
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1306
Practice Address - Country:US
Practice Address - Phone:251-809-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1800523336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136881OtherNCPDP PROVIDER IDENTIFICATION NUMBER