Provider Demographics
NPI:1760557227
Name:INDEPENDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:INDEPENDENT HEALTH SERVICES
Other - Org Name:IHS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP AND GENERAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:256-638-1060
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986
Mailing Address - Country:US
Mailing Address - Phone:256-638-1060
Mailing Address - Fax:256-638-1061
Practice Address - Street 1:504 MCCURDY AVE SW
Practice Address - Street 2:STE 100
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-1060
Practice Address - Fax:256-638-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1115703336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10003088Medicaid
0129331OtherNABP