Basic Information
| Provider Information | |||||||||
| NPI: | 1659625291 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HMR OF ALABAMA INC | ||||||||
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| OtherOrganizationName: | GSI PHARMACY OF ALEXANDER CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 JUSTICE LN | ||||||||
| Address2: | PO BOX 5285 | ||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296212354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642243898 | ||||||||
| FaxNumber: | 8642243609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1784 ELKAHATCHEE RD | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350104800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563290868 | ||||||||
| FaxNumber: | 2563291101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2012 | ||||||||
| LastUpdateDate: | 02/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | HILLIARD | ||||||||
| AuthorizedOfficialFirstName: | HEYWARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8642243898 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336L0003X | 180182 | AL | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2146920 | 01 | PK | OTHER |