1033423199 NPI number — MONTGOMERY DRUG COMPANY INC

Table of content: (NPI 1033423199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033423199 NPI number — MONTGOMERY DRUG COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY DRUG COMPANY INC
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:
6
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:
1033423199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 COPPERFIELD DR
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-386-9370
Provider Business Mailing Address Fax Number:
334-386-9371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 COPPERFIELD DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-7100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-386-9370
Provider Business Practice Location Address Fax Number:
334-386-9371
Provider Enumeration Date:
08/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PHUNG
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
334-272-0802

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  113429 , 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)

  • Identifier: 0136641 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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