Provider Demographics
NPI:1912862202
Name:PIKE ROAD PHARMACY
Entity type:Organization
Organization Name:PIKE ROAD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-202-1104
Mailing Address - Street 1:9558 VAUGHN ROAD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064
Mailing Address - Country:US
Mailing Address - Phone:334-398-7765
Mailing Address - Fax:334-398-7841
Practice Address - Street 1:9558 VAUGHN ROAD
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064
Practice Address - Country:US
Practice Address - Phone:334-398-7765
Practice Address - Fax:334-398-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-18
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy