NPIMap

Organization Active NPI

Choice Source Therapeutic South LLC

  • Specialty Pharmacy
  • Daphne, AL
National Provider Identifier
1720069628
Registry record updated Aug 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
CHOICE SOURCE THERAPEUTIC SOUTH LLC
Practice address
1048 Stanton Rd
Suite a
Daphne, AL 36526-4294
Phone
(251) 621-5300
Fax
(251) 621-5318
NPI assigned
Nov 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David William Border
Title
Authorized Signer
Phone
(800) 225-5967

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 112079 AL
Pharmacy 333600000X 112079 AL
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

1048 Stanton Rd
Suite a
Daphne, AL 36526-4294

Mailing address

Department 6175
Los Angeles, CA 90088-6175
Phone (800) 225-5967

Other identifiers 1

IdentifierTypeStateIssuer
0330543MedicaidMS

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1048 Stanton Rd
Ste A
Daphne, AL 36526
Phone (251) 621-5300

27004 Network Pl
Chicago, IL 60673

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1720069628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT 6175",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900886175",
            "telephone_number": "800-225-5967",
            "fax_number": "909-799-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 STANTON RD",
            "address_2": "SUITE A",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365264294",
            "telephone_number": "251-621-5300",
            "fax_number": "251-621-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOICE SOURCE THERAPEUTIC SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "BORDER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "AUTHORIZED SIGNER",
        "authorized_official_telephone_number": "800-225-5967",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "112079",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AL",
            "license": "112079",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330543",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daphne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.