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
Certification Date: 2022-08-04
Details
| Name | Value | ||||||||||||||||
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| NPI | 1194452656 | ||||||||||||||||
| Enumeration Date | 2022-08-04 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| 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 | ||||||||||||||||
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