Provider Demographics
NPI:1659385417
Name:DAUGHTRY PHARMACY
Entity Type:Organization
Organization Name:DAUGHTRY PHARMACY
Other - Org Name:TED'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-685-2703
Mailing Address - Street 1:602 ROYAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6968
Mailing Address - Country:US
Mailing Address - Phone:334-712-1034
Mailing Address - Fax:
Practice Address - Street 1:405 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1606
Practice Address - Country:US
Practice Address - Phone:334-493-4541
Practice Address - Fax:334-493-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies