Provider Demographics
NPI:1548787898
Name:SALEM PHARMACY
Entity Type:Organization
Organization Name:SALEM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-216-1820
Mailing Address - Street 1:28730 AL HIGHWAY 99 STE A
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-7952
Mailing Address - Country:US
Mailing Address - Phone:256-216-1820
Mailing Address - Fax:256-216-1823
Practice Address - Street 1:28730 AL HIGHWAY 99 STE A
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-7952
Practice Address - Country:US
Practice Address - Phone:256-216-1820
Practice Address - Fax:256-216-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1147383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy