Provider Demographics
NPI:1205261567
Name:DCA PHARMACY
Entity type:Organization
Organization Name:DCA PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFNEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-562-7912
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:COALING
Mailing Address - State:AL
Mailing Address - Zip Code:35449-0006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15329 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:COALING
Practice Address - State:AL
Practice Address - Zip Code:35453-2408
Practice Address - Country:US
Practice Address - Phone:205-562-7912
Practice Address - Fax:205-562-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X
AL1141913336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141837OtherPK