Provider Demographics
NPI:1710101423
Name:GULF SHORES PHARMACY, INC.
Entity type:Organization
Organization Name:GULF SHORES PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROTHBARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-968-3784
Mailing Address - Street 1:251 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3415
Mailing Address - Country:US
Mailing Address - Phone:251-968-3784
Mailing Address - Fax:251-968-3785
Practice Address - Street 1:251 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3415
Practice Address - Country:US
Practice Address - Phone:251-968-3784
Practice Address - Fax:251-968-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty