Provider Demographics
NPI: | 1710101423 |
---|---|
Name: | GULF SHORES PHARMACY, INC. |
Entity Type: | Organization |
Organization Name: | GULF SHORES PHARMACY, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | JAY |
Authorized Official - Last Name: | ROTHBARDT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 251-968-3784 |
Mailing Address - Street 1: | 251 CLUBHOUSE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | GULF SHORES |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36542-3415 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-968-3784 |
Mailing Address - Fax: | 251-968-3785 |
Practice Address - Street 1: | 251 CLUBHOUSE DR |
Practice Address - Street 2: | |
Practice Address - City: | GULF SHORES |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36542-3415 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-968-3784 |
Practice Address - Fax: | 251-968-3785 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-12 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 12413 | 183500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Single Specialty |