Basic Information
| Provider Information | |||||||||
| NPI: | 1740534387 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HMR OF ALABAMA INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GSI PHARMACY OF BAY MINETTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 5285 | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642243898 | ||||||||
| FaxNumber: | 8642243609 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 FAULKNER DR | ||||||||
| Address2: | |||||||||
| City: | BAY MINETTE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365072771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519379881 | ||||||||
| FaxNumber: | 2519379804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2012 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TWITTY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VP | ||||||||
| AuthorizedOfficialTelephone: | 8642243898 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | 180183 | AL | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2146921 | 01 | PK | OTHER |