Provider Demographics
NPI:1588963441
Name:FLORALA PHARMACY INC
Entity type:Organization
Organization Name:FLORALA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:334-858-3291
Mailing Address - Street 1:23355 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442
Mailing Address - Country:US
Mailing Address - Phone:334-858-3291
Mailing Address - Fax:334-858-5254
Practice Address - Street 1:1133 DR M L K JR EXPY
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-2233
Practice Address - Country:US
Practice Address - Phone:334-427-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORALA PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1134933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy