Provider Demographics
NPI:1801941000
Name:PHARMACY XPRESS INC.
Entity type:Organization
Organization Name:PHARMACY XPRESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-744-4480
Mailing Address - Street 1:2910 ALLISON BONNETT MEM DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023
Mailing Address - Country:US
Mailing Address - Phone:205-744-4480
Mailing Address - Fax:
Practice Address - Street 1:2910 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:SUITE 112
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1876
Practice Address - Country:US
Practice Address - Phone:205-744-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52233332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001866Medicaid
AL52233Medicare ID - Type Unspecified