Provider Demographics
NPI:1821392366
Name:PHARMACY OF MADISON, LLC
Entity Type:Organization
Organization Name:PHARMACY OF MADISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:SPEEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-227-8467
Mailing Address - Street 1:186 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5002
Mailing Address - Country:US
Mailing Address - Phone:205-487-3079
Mailing Address - Fax:205-487-3138
Practice Address - Street 1:97 HUGHES RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3400
Practice Address - Country:US
Practice Address - Phone:256-227-8467
Practice Address - Fax:256-771-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-24
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy