Provider Demographics
NPI:1336222959
Name:FAIRHOPE PHARMACY INC
Entity Type:Organization
Organization Name:FAIRHOPE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:251-928-8822
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-928-8822
Mailing Address - Fax:251-928-3357
Practice Address - Street 1:398 FAIRHOPE AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-928-8822
Practice Address - Fax:251-928-3357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRHOPE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103830333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000153Medicaid
0102981OtherNABP
0102981OtherNABP
AL100000153Medicaid
AF0474293OtherDEA