Provider Demographics
NPI:1619045382
Name:MEDICINE CHEST WELLNESS CENTER INC
Entity Type:Organization
Organization Name:MEDICINE CHEST WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:OWNES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-621-2310
Mailing Address - Street 1:514 FIRST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007
Mailing Address - Country:US
Mailing Address - Phone:205-621-2310
Mailing Address - Fax:205-621-2318
Practice Address - Street 1:514 FIRST STREET NORTH
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007
Practice Address - Country:US
Practice Address - Phone:205-621-2310
Practice Address - Fax:205-621-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22271183500000X
AL1000063063332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129103OtherNCPDP
AL100003063Medicaid
AL1266980001Medicare ID - Type Unspecified
AL1266980001Medicare NSC