Provider Demographics
NPI:1336557446
Name:HH HEALTH SYSTEM - RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:HH HEALTH SYSTEM - RETAIL PHARMACY LLC
Other - Org Name:KELLER COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-2853
Mailing Address - Street 1:1300 S MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660
Mailing Address - Country:US
Mailing Address - Phone:256-386-4600
Mailing Address - Fax:256-386-4767
Practice Address - Street 1:1300 S. MONTGOMERY AVE.
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660
Practice Address - Country:US
Practice Address - Phone:256-386-4600
Practice Address - Fax:256-386-4676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HH HEALTH SYSTEM SHOALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL114369333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL186575Medicaid
2146996OtherPK