Organization
MARBLE CITY PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB MILES JOHNSON PHARMD (OWNER)
(256) 245-4446
Entity
Organization
Contact information
Practice address
264 W FORT WILLIAMS ST, SYLACAUGA, AL 35150-2432
(256) 245-4446
(256) 245-4484
Mailing address
264 W FORT WILLIAMS ST, SYLACAUGA, AL 35150-2432
(256) 245-4446
(256) 245-4484
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
112273
AL
332B00000X
Durable Medical Equipment & Medical Supplies
112273
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932695
—
AL
01
—
0131730
NABP
AL
05
—
100003479
—
AL
Enumeration date
07/05/2005
Last updated
12/29/2010
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