Provider Demographics
NPI:1730257536
Name:CENTRAL HEIGHTS PHARMACY INC
Entity type:Organization
Organization Name:CENTRAL HEIGHTS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-766-4200
Mailing Address - Street 1:11350 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-2702
Mailing Address - Country:US
Mailing Address - Phone:256-766-4200
Mailing Address - Fax:256-766-9566
Practice Address - Street 1:11350 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-2702
Practice Address - Country:US
Practice Address - Phone:256-766-4200
Practice Address - Fax:256-766-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 333600000X
AL1115753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935310Medicaid
1992713OtherPK
1992713OtherPK