Organization
MEDICAL CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY GREG LANE RPH (OWNER RPH)
(256) 332-4021
Entity
Organization
Contact information
Practice address
609 GANDY ST NE, RUSSELLVILLE, AL 35653
(256) 331-9060
(256) 332-4210
Mailing address
609 GANDY ST NE, RUSSELLVILLE, AL 35653
(256) 331-9060
(256) 332-4210
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
106725
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123935
NCPDP
—
05
—
100002480
—
AL
Enumeration date
03/22/2006
Last updated
07/03/2008
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