Provider Demographics
NPI:1659669976
Name:INJURY MED EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:INJURY MED EXPRESS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-832-2263
Mailing Address - Street 1:1410 US HIGHWAY 98
Mailing Address - Street 2:UNIT H
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5110
Mailing Address - Country:US
Mailing Address - Phone:888-418-9808
Mailing Address - Fax:888-484-5016
Practice Address - Street 1:1410 US HIGHWAY 98
Practice Address - Street 2:UNIT H
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5110
Practice Address - Country:US
Practice Address - Phone:888-418-9808
Practice Address - Fax:888-484-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336C0003X
PANP000017333600000X
AL1137823336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131252OtherPK