# PCM PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROFESSIONAL CUSTOMIZED MEDICATIONS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831104462
- **Authorized official:** WILLIAM WOOD RPH (MGR MEMBER)
- **Authorized official phone:** (256) 757-1956

## Contact information

- **Practice address:** 1621 HIGHWAY 72, KILLEN, AL 35645-9142
- **Practice address phone:** (256) 757-1956
- **Practice address fax:** (256) 757-1936
- **Mailing address:** PO BOX 99, KILLEN, AL 35645-0099
- **Mailing address phone:** (256) 757-1956
- **Mailing address fax:** (256) 757-1936

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | 111538 | AL | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 07/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0129191 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 100003101 | — | AL |