Provider Demographics
NPI:1639122542
Name:PHARMACY PARTNERS LLC
Entity Type:Organization
Organization Name:PHARMACY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:256-638-6667
Mailing Address - Street 1:1248 MAIN ST
Mailing Address - Street 2:PO BOX 410
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-3471
Mailing Address - Country:US
Mailing Address - Phone:256-638-6667
Mailing Address - Fax:256-638-6658
Practice Address - Street 1:1248 MAIN ST
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971-3471
Practice Address - Country:US
Practice Address - Phone:256-638-6667
Practice Address - Fax:256-638-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10229302R00000X
3336L0003X
AL3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003112Medicaid
AL5721950001Medicare NSC