Provider Demographics
NPI:1710992300
Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Other - Org Name:EAMC HOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-821-7843
Mailing Address - Street 1:665 OPELIKA RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4013
Mailing Address - Country:US
Mailing Address - Phone:334-821-7843
Mailing Address - Fax:334-821-8894
Practice Address - Street 1:665 OPELIKA RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4013
Practice Address - Country:US
Practice Address - Phone:334-821-7843
Practice Address - Fax:334-821-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
AL1112723336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0128579OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL100010006Medicaid
1148230001Medicare NSC