Provider Demographics
NPI:1629119003
Name:HADDER PHARMACY INC
Entity Type:Organization
Organization Name:HADDER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:HADDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-622-3030
Mailing Address - Street 1:10303 MAIN STREET
Mailing Address - Street 2:PO BOX 380
Mailing Address - City:OAKMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35579
Mailing Address - Country:US
Mailing Address - Phone:205-622-3030
Mailing Address - Fax:205-622-3007
Practice Address - Street 1:10303 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OAKMAN
Practice Address - State:AL
Practice Address - Zip Code:35579
Practice Address - Country:US
Practice Address - Phone:205-622-3030
Practice Address - Fax:205-622-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104870333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0123581OtherNABP NUMBER