Provider Demographics
NPI:1821646894
Name:SENIOR CARE PHARMACY INC
Entity Type:Organization
Organization Name:SENIOR CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:251-264-6110
Mailing Address - Street 1:101B VILLA DR STE B-260
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4653
Mailing Address - Country:US
Mailing Address - Phone:251-264-6110
Mailing Address - Fax:877-583-0120
Practice Address - Street 1:101B VILLA DR STE B-260
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4653
Practice Address - Country:US
Practice Address - Phone:251-264-6110
Practice Address - Fax:877-583-0120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR CARE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy