Provider Demographics
NPI:1023029691
Name:SYLVANIA PHARMACY INC.
Entity type:Organization
Organization Name:SYLVANIA PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-638-6070
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:AL
Mailing Address - Zip Code:35988-0285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 INDUSTRIAL DR.
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:AL
Practice Address - Zip Code:35988-2273
Practice Address - Country:US
Practice Address - Phone:256-638-6070
Practice Address - Fax:256-638-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0133986OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL5779770001Medicare NSC