Provider Demographics
NPI:1184069189
Name:DAPHNE PHARMACY LLC
Entity type:Organization
Organization Name:DAPHNE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-509-0616
Mailing Address - Street 1:2101 US HIGHWAY 98
Mailing Address - Street 2:STE K
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4295
Mailing Address - Country:US
Mailing Address - Phone:251-509-0616
Mailing Address - Fax:251-509-0620
Practice Address - Street 1:2101 US HIGHWAY 98
Practice Address - Street 2:STE K
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4295
Practice Address - Country:US
Practice Address - Phone:251-509-0616
Practice Address - Fax:251-509-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1141063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140413OtherPK