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Provider Information for 1194452656


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MEDICUS SPECIALTY PHARMACY

Organization Subpart: NO

NPI: 1194452656
Last Updated: 2022-08-04
Certification Date: 2022-08-04

Details

NameValue
NPI1194452656
Enumeration Date2022-08-04
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Dr. JOHN W TOLE DO
Title: Owner / Physician
Phone: 3345217408
Mailing Address 1925 E GLENN AVE STE 204
AUBURN, AL 36830-5729
United States

Phone: 334-521-7408 | Fax:334-521-0394
 
Primary Practice Address 1925 E GLENN AVE STE 204
AUBURN, AL 36830-5729
United States

Phone: 334-521-7408 | Fax:334-521-0394
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
No 3336S0011X - Pharmacy - Specialty Pharmacy
Yes 3336C0002X - Pharmacy - Clinic Pharmacy