Provider Demographics
NPI:1699372771
Name:MEDICINE SHOPPE 0804 INC
Entity type:Organization
Organization Name:MEDICINE SHOPPE 0804 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:256-350-3338
Mailing Address - Street 1:2006 DANVILLE RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4640
Mailing Address - Country:US
Mailing Address - Phone:256-350-3338
Mailing Address - Fax:256-350-9829
Practice Address - Street 1:2006 DANVILLE RD SW STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4640
Practice Address - Country:US
Practice Address - Phone:256-350-3338
Practice Address - Fax:256-350-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy