1801899463 NPI number — PILCHER MCBRYDE DRUG COMPANY

Table of content: (NPI 1801899463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801899463 NPI number — PILCHER MCBRYDE DRUG COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PILCHER MCBRYDE 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:
1801899463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36702-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-875-7208
Provider Business Mailing Address Fax Number:
334-875-2855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-7208
Provider Business Practice Location Address Fax Number:
334-875-2855
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CREECH, JR.
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT/ CO-OWNER
Authorized Official Telephone Number:
334-875-7208

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  107790 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 107790 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 107790 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 107790 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 51051380 . This is a "AL BS BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100000225 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0109618 . This is a "NABP OR NCPDP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009806250 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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