Provider Demographics
NPI:1831463561
Name:PHARMALA SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:PHARMALA SPECIALTY PHARMACY LLC
Other - Org Name:PHARMSOUTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-991-5265
Mailing Address - Street 1:34 MANNING PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1809
Mailing Address - Country:US
Mailing Address - Phone:205-991-5265
Mailing Address - Fax:205-991-5295
Practice Address - Street 1:34 MANNING PL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1809
Practice Address - Country:US
Practice Address - Phone:205-991-5265
Practice Address - Fax:205-991-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL136226Medicaid