Provider Demographics
NPI:1245329820
Name:SERVICE FIRST PHARMACIES
Entity type:Organization
Organization Name:SERVICE FIRST PHARMACIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:AMOS
Authorized Official - Last Name:WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-837-1778
Mailing Address - Street 1:8 PARADE ST NW STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4848
Mailing Address - Country:US
Mailing Address - Phone:256-837-1778
Mailing Address - Fax:256-837-0357
Practice Address - Street 1:8 PARADE ST NW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4848
Practice Address - Country:US
Practice Address - Phone:256-837-1778
Practice Address - Fax:256-837-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1064453336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106445OtherSTATE LICENSE NUMBER