Provider Demographics
NPI:1740225622
Name:HALEYVILLE MEDICAL ARTS DRUGS INC
Entity Type:Organization
Organization Name:HALEYVILLE MEDICAL ARTS DRUGS INC
Other - Org Name:MEDICAL ARTS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:205-486-3133
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0575
Mailing Address - Country:US
Mailing Address - Phone:205-486-3133
Mailing Address - Fax:205-486-8966
Practice Address - Street 1:42322 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7064
Practice Address - Country:US
Practice Address - Phone:205-486-3133
Practice Address - Fax:205-486-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1066103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001802Medicaid
2142930OtherPK
0123930001Medicare NSC
AL100001802Medicaid