Provider Demographics
NPI:1902198724
Name:QUALITY OF LIFE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:QUALITY OF LIFE HEALTH SERVICES INC
Other - Org Name:WOODLAND QUALITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-393-4063
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-393-4063
Mailing Address - Fax:256-543-0340
Practice Address - Street 1:24460 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:AL
Practice Address - Zip Code:36280-5204
Practice Address - Country:US
Practice Address - Phone:256-449-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336M0002X
AL1136953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137124OtherNCPDP PROVIDER IDENTIFICATION NUMBER