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Organization
FAF INC
Active
Organization
FAF INC
Active
Other names
Sparkman Pharmacy at Wellstone
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY WATSON (PHCY MANGER/AO)
(256) 705-6499
Entity
Organization
Contact information
Practice address
4040 MEMORIAL PKWY SW STE L, HUNTSVILLE, AL 35802-4364
(256) 705-6499
(256) 705-6497
Mailing address
4040 MEMORIAL PKWY SW STE L, HUNTSVILLE, AL 35802-4364
(256) 705-6499
(256) 705-6497
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
114561
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182372
—
AL
01
—
2155730
PK
—
Enumeration date
11/30/2015
Last updated
12/09/2019
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