Provider Demographics
NPI:1538285499
Name:MEDICAL ARTS PHARMACY, INC.
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-794-4191
Mailing Address - Street 1:219 FORTNER ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2405
Mailing Address - Country:US
Mailing Address - Phone:334-794-4191
Mailing Address - Fax:334-793-5742
Practice Address - Street 1:219 FORTNER ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2405
Practice Address - Country:US
Practice Address - Phone:334-794-4191
Practice Address - Fax:334-793-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110705332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0126820001Medicare ID - Type UnspecifiedPROVIDER ID