Provider Demographics
NPI:1104123645
Name:SEMMES PHARMACY LLC
Entity type:Organization
Organization Name:SEMMES PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-645-7979
Mailing Address - Street 1:8985 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5311
Mailing Address - Country:US
Mailing Address - Phone:251-645-7979
Mailing Address - Fax:251-645-9008
Practice Address - Street 1:8985 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5311
Practice Address - Country:US
Practice Address - Phone:251-645-7979
Practice Address - Fax:251-645-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1136483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127919Medicaid
2129608OtherPK