Provider Demographics
NPI:1972775526
Name:MONROVIA FAMILY PHARMACY
Entity Type:Organization
Organization Name:MONROVIA FAMILY PHARMACY
Other - Org Name:MONROVIA FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-721-0128
Mailing Address - Street 1:7190 WALL TRIANA HWY
Mailing Address - Street 2:STE B AND C
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-7464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7190 WALL TRIANA HWY
Practice Address - Street 2:STE B AND C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-7464
Practice Address - Country:US
Practice Address - Phone:256-726-0208
Practice Address - Fax:256-726-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AL1130823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0135221OtherOTHER ID NUMBER