1336557446 NPI number — HH HEALTH SYSTEM - RETAIL PHARMACY LLC

Table of content: (NPI 1336557446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336557446 NPI number — HH HEALTH SYSTEM - RETAIL PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HH HEALTH SYSTEM - RETAIL PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KELLER COMMUNITY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336557446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 S MONTGOMERY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEFFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-386-4600
Provider Business Mailing Address Fax Number:
256-386-4767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 S. MONTGOMERY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEFFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-386-4600
Provider Business Practice Location Address Fax Number:
256-386-4676
Provider Enumeration Date:
08/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SAMZ
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP
Authorized Official Telephone Number:
256-265-2853

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  114369 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 114369 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 186575 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2146996 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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