Provider Demographics
NPI:1902377716
Name:SYLACAUGA PHARMACY, LLC
Entity Type:Organization
Organization Name:SYLACAUGA PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:HANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-208-9595
Mailing Address - Street 1:PO BOX 381134
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-1134
Mailing Address - Country:US
Mailing Address - Phone:256-208-9595
Mailing Address - Fax:
Practice Address - Street 1:1244 TALLADEGA HWY
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1603
Practice Address - Country:US
Practice Address - Phone:256-208-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy