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Organization

CHOICE SOURCE THERAPEUTIC SOUTH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID WILLIAM BORDER (AUTHORIZED SIGNER)
(800) 225-5967
Entity
Organization

Contact information

Practice address
1048 STANTON RD, SUITE A, DAPHNE, AL 36526-4294
(251) 621-5300
(251) 621-5318
Mailing address
DEPARTMENT 6175, LOS ANGELES, CA 90088-6175
(800) 225-5967
(909) 799-4364

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
112079
AL
333600000X
Pharmacy
112079
AL
3336S0011X
Specialty Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0330543
MS
Enumeration date
11/08/2005
Last updated
08/20/2007
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