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Organization
CHOICE SOURCE THERAPEUTIC SOUTH LLC
Active
Organization
CHOICE SOURCE THERAPEUTIC SOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID WILLIAM BORDER (AUTHORIZED SIGNER)
(800) 225-5967
Entity
Organization
Contact information
Practice address
1048 STANTON RD, SUITE A, DAPHNE, AL 36526-4294
(251) 621-5300
(251) 621-5318
Mailing address
DEPARTMENT 6175, LOS ANGELES, CA 90088-6175
(800) 225-5967
(909) 799-4364
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
112079
AL
333600000X
Pharmacy
112079
AL
3336S0011X
Specialty Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330543
—
MS
Enumeration date
11/08/2005
Last updated
08/20/2007
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