Organization
COOSA VALLEY APOTHECARY LL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROLAND THACKER (CFO)
(256) 401-4534
Entity
Organization
Contact information
Practice address
315 W HICKORY ST STE 150, SYLACAUGA, AL 35150-2913
(256) 401-4534
(256) 401-4603
Mailing address
315 W HICKORY ST STE 150, SYLACAUGA, AL 35150-2913
(256) 401-4534
(256) 401-4603
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/04/2019
Last updated
04/08/2019
Update your record
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