Provider Demographics
NPI:1093189821
Name:INTERLINK APOTHECARY
Entity type:Organization
Organization Name:INTERLINK APOTHECARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-872-2326
Mailing Address - Street 1:618 MEDICAL CENTER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6704
Mailing Address - Country:US
Mailing Address - Phone:334-875-7688
Mailing Address - Fax:
Practice Address - Street 1:618 MEDICAL CENTER PKWY STE B
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6704
Practice Address - Country:US
Practice Address - Phone:334-875-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1145543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114554OtherSTATE PHARMACY LICENSE NUMBER