Organization
DURA MED SOUTHEAST INC
Active
Other names
FLOMATON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY BLACKMAN RPH (SUPERVISING PHARMACIST)
(251) 296-4224
Entity
Organization
Contact information
Practice address
174 HIGHWAY 113, FLOMATON, AL 36441-4556
(251) 296-4224
(251) 296-4226
Mailing address
174 HIGHWAY 113, PO BOX 1018, FLOMATON, AL 36441-4556
(251) 296-4224
(251) 296-4226
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
111970
AL
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0133645
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
031884100
—
AL
05
—
100003505
—
AL
Enumeration date
07/06/2006
Last updated
02/22/2010
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