Provider Demographics
NPI:1932296183
Name:MEDAUS PHARMACY AND COMPOUNDING CENTER
Entity Type:Organization
Organization Name:MEDAUS PHARMACY AND COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:205-981-2352
Mailing Address - Street 1:6801 CAHABA VALLEY RD STE 116
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-9609
Mailing Address - Country:US
Mailing Address - Phone:205-981-2352
Mailing Address - Fax:205-981-2767
Practice Address - Street 1:6801 CAHABA VALLEY RD STE 116
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-9609
Practice Address - Country:US
Practice Address - Phone:205-981-2352
Practice Address - Fax:205-981-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1112153336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0128149OtherNCPDP