Provider Demographics
NPI:1245913144
Name:USA HEALTH PROVIDENCE RETAIL PHARMACY LLC
Entity type:Organization
Organization Name:USA HEALTH PROVIDENCE RETAIL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-850-6120
Mailing Address - Street 1:307 N UNIVERSITY BLVD # AD300
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-3053
Mailing Address - Country:US
Mailing Address - Phone:251-461-1475
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD STE B 124
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-3053
Practice Address - Country:US
Practice Address - Phone:251-266-2860
Practice Address - Fax:251-631-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy