Organization
SOUTHEAST PHARMACEUTICALS, INC
Active
Other names
SOUTHEAST PHARMACEUTICALS VITAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN NEAL HOLLEY RPH. (PRESIDENT)
(334) 897-3746
Entity
Organization
Contact information
Practice address
704 TROY HWY, STE A, ELBA, AL 36323-1521
(334) 897-3746
(334) 897-3716
Mailing address
PO BOX 415, ELBA, AL 36323-0415
(334) 897-3746
(334) 897-3716
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
110474
AL
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
110474
AL
332BC3200X
Customized Equipment (DME)
110474
AL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
110474
AL
332BX2000X
Oxygen Equipment & Supplies (DME)
110474
AL
333600000X
Pharmacy
110474
AL
3336C0003X
Community/Retail Pharmacy
110474
AL
3336H0001X
Home Infusion Therapy Pharmacy
110474
AL
3336L0003X
Long Term Care Pharmacy
110474
AL
3336M0002X
Mail Order Pharmacy
110474
AL
3336S0011X
Specialty Pharmacy
110474
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009505350
—
AL
05
—
100002728
—
AL
05
—
106273500
—
FL
01
—
510-36152
BCBS DME
AL
Enumeration date
08/30/2006
Last updated
01/29/2010
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