1144708074 NPI number — SGJ PHARMACY SERVICES INC.

Table of content: (NPI 1144708074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144708074 NPI number — SGJ PHARMACY SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SGJ PHARMACY SERVICES INC.
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:
Provider Other Organization Name Type Code:
6
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:
1144708074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 GOODYEAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35903-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-456-5850
Provider Business Mailing Address Fax Number:
256-467-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 PELHAM RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36265-2773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-913-2023
Provider Business Practice Location Address Fax Number:
256-913-2024
Provider Enumeration Date:
08/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BARRON
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
BROWN
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
256-456-5850

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  114832 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AL-114832 . This is a "ALABAMA STATE BOARD OF PHARMACY LICENSE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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