Provider Demographics
NPI:1568527711
Name:SPECIAL FORMULA PRESCRIPTIONS INC
Entity Type:Organization
Organization Name:SPECIAL FORMULA PRESCRIPTIONS INC
Other - Org Name:SPECIAL FORMULA PRESCRIPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-7445
Mailing Address - Street 1:3918 MONTCLAIR RD
Mailing Address - Street 2:STE 203
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2425
Mailing Address - Country:US
Mailing Address - Phone:205-871-7445
Mailing Address - Fax:205-871-7446
Practice Address - Street 1:3918 MONTCLAIR RD
Practice Address - Street 2:STE 203
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-2425
Practice Address - Country:US
Practice Address - Phone:205-871-7445
Practice Address - Fax:205-871-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1117163336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140168OtherPK