# COOSA VALLEY APOTHECARY LL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588126809
- **Authorized official:** MR. ROLAND THACKER (CFO)
- **Authorized official phone:** (256) 401-4534

## Contact information

- **Practice address:** 315 W HICKORY ST STE 150, SYLACAUGA, AL 35150-2913
- **Practice address phone:** (256) 401-4534
- **Practice address fax:** (256) 401-4603
- **Mailing address:** 315 W HICKORY ST STE 150, SYLACAUGA, AL 35150-2913
- **Mailing address phone:** (256) 401-4534
- **Mailing address fax:** (256) 401-4603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/04/2019
- **Last updated:** 04/08/2019