Provider Demographics
NPI:1508588070
Name:HEADLAND PHARMACY LLC
Entity Type:Organization
Organization Name:HEADLAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-797-7992
Mailing Address - Street 1:300 N DEAN RD
Mailing Address - Street 2:SUITE 5 NUMBER 202
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-797-7992
Mailing Address - Fax:
Practice Address - Street 1:17920 US HIGHWAY 431 S
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345-8449
Practice Address - Country:US
Practice Address - Phone:334-785-8045
Practice Address - Fax:334-785-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy