1154340750 NPI number — WEARS DRUGS INC

Table of content: (NPI 1154340750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154340750 NPI number — WEARS DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEARS DRUGS 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:
1154340750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWN CREEK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35672-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-685-3530
Provider Business Mailing Address Fax Number:
256-685-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 AL HWY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWN CREEK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-685-3530
Provider Business Practice Location Address Fax Number:
256-685-3523
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEAR
Authorized Official First Name:
FLAVIL
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
256-685-3530

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  110414 , 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: 009936220 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100003177 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936220 . This is a "MEDICAID DME NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051554446WAE . This is a "MEDICARE FLU SHOT NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110414 . This is a "PHARAMCY LICENSE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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