1285789255 NPI number — EUTAW DRUG COMPANY

Table of content: MS. ANNETTE ROSSI MANNION CPNP (NPI 1992034219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285789255 NPI number — EUTAW DRUG COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUTAW DRUG COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285789255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUTAW
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35462-0390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-372-3346
Provider Business Mailing Address Fax Number:
205-372-0639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUTAW
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35462-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-372-3346
Provider Business Practice Location Address Fax Number:
205-372-0639
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DURRETT
Authorized Official First Name:
CECIL
Authorized Official Middle Name:
NORMAN
Authorized Official Title or Position:
CHIEF PHARMACISTS
Authorized Official Telephone Number:
205-372-3346

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7662 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)