Provider Demographics
NPI:1952761751
Name:SPECIALTY PHARMACY OF THE SHOALS
Entity Type:Organization
Organization Name:SPECIALTY PHARMACY OF THE SHOALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-366-3571
Mailing Address - Street 1:1404 E AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1773
Mailing Address - Country:US
Mailing Address - Phone:256-389-1358
Mailing Address - Fax:256-389-1359
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-389-1358
Practice Address - Fax:256-389-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy