Provider Demographics
NPI:1982854667
Name:OAK PARK PHARMACY
Entity type:Organization
Organization Name:OAK PARK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-528-2473
Mailing Address - Street 1:1365 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2834
Mailing Address - Country:US
Mailing Address - Phone:334-826-7200
Mailing Address - Fax:334-528-1534
Practice Address - Street 1:1365 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2834
Practice Address - Country:US
Practice Address - Phone:334-826-7200
Practice Address - Fax:334-528-1534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ALABAMA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy