Provider Demographics
NPI:1578937488
Name:MARGARET PHARMACY LLC
Entity Type:Organization
Organization Name:MARGARET PHARMACY LLC
Other - Org Name:MARGARET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-319-1999
Mailing Address - Street 1:145 JEFFREY WILSON DR
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-5575
Mailing Address - Country:US
Mailing Address - Phone:205-319-1999
Mailing Address - Fax:205-629-0301
Practice Address - Street 1:145 JEFFREY WILSON DR
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-5575
Practice Address - Country:US
Practice Address - Phone:205-319-1999
Practice Address - Fax:205-629-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
AL1145483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155060OtherPK
AL179889Medicaid