Provider Demographics
NPI:1053526368
Name:SOUTHEAST ALABAMA MEDICAL CENTER EMPLOYEE PHARMACY
Entity type:Organization
Organization Name:SOUTHEAST ALABAMA MEDICAL CENTER EMPLOYEE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-8701
Mailing Address - Street 1:PO BOX 6987
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6987
Mailing Address - Country:US
Mailing Address - Phone:334-793-8113
Mailing Address - Fax:334-712-3701
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-793-8113
Practice Address - Fax:334-712-3701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON COUNTY HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL150080333600000X
AL113196333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy