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Organization
SYLACAUGA HEALTH CARE AUTHORITY INC
Active
Organization
SYLACAUGA HEALTH CARE AUTHORITY INC
Active
Other names
COOSA VALLEY MEDICAL CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CRANE BSPHARM (DIRECTOR OF PHARMACY)
(256) 401-4066
Entity
Organization
Contact information
Practice address
315 W HICKORY ST, SYLACAUGA, AL 35150-2913
(256) 401-4065
(256) 401-4099
Mailing address
315 W HICKORY ST, SYLACAUGA, AL 35150-2913
(256) 401-4065
(256) 401-4099
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
130008
AL
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100010002
—
AL
01
—
1989675
PK
—
Enumeration date
06/15/2006
Last updated
02/21/2017
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