Provider Demographics
NPI:1902220932
Name:MEDCHOICE PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:MEDCHOICE PHARMACY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:850-381-1433
Mailing Address - Street 1:1 SOUTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1210
Mailing Address - Country:US
Mailing Address - Phone:850-215-9428
Mailing Address - Fax:850-215-9428
Practice Address - Street 1:1 SOUTHERN WAY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-1210
Practice Address - Country:US
Practice Address - Phone:251-544-9500
Practice Address - Fax:250-544-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1142923336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid