Provider Demographics
NPI:1619022928
Name:LADAS PHARMACY
Entity Type:Organization
Organization Name:LADAS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-432-5601
Mailing Address - Street 1:1050 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-1038
Mailing Address - Country:US
Mailing Address - Phone:251-432-5601
Mailing Address - Fax:251-441-0012
Practice Address - Street 1:1050 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-1038
Practice Address - Country:US
Practice Address - Phone:251-432-5601
Practice Address - Fax:251-441-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105940332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000306Medicaid