Provider Demographics
NPI:1518403914
Name:GENERIC PHARMACY-DOTHAN LLC
Entity Type:Organization
Organization Name:GENERIC PHARMACY-DOTHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-798-1827
Mailing Address - Street 1:2115 E MAIN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3044
Mailing Address - Country:US
Mailing Address - Phone:334-798-1827
Mailing Address - Fax:334-446-3010
Practice Address - Street 1:2115 E MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3044
Practice Address - Country:US
Practice Address - Phone:334-798-1827
Practice Address - Fax:334-446-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL114685333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167709OtherPK