Provider Demographics
NPI:1154693737
Name:DOUBLE OAK MOUNTAIN PHARMACY LLC
Entity type:Organization
Organization Name:DOUBLE OAK MOUNTAIN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/TCH/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FEICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-991-0800
Mailing Address - Street 1:5510 HIGHWAY 280 STE 123
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6582
Mailing Address - Country:US
Mailing Address - Phone:205-991-0800
Mailing Address - Fax:205-991-0810
Practice Address - Street 1:5510 HIGHWAY 280 STE 123
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6582
Practice Address - Country:US
Practice Address - Phone:205-991-0800
Practice Address - Fax:205-991-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AL1138543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133626OtherPK
AL135221Medicaid
1026739021Medicare NSC