1922116615 NPI number — J & A PHARMACY INC CENTRE

Table of content: (NPI 1922116615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922116615 NPI number — J & A PHARMACY INC CENTRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J & A PHARMACY INC CENTRE
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:
1922116615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 JD SMITH DRIVE
Provider Second Line Business Mailing Address:
ALACO WAREHOUSE - BUSINESS OFFICE
Provider Business Mailing Address City Name:
ATTALLA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35954-3350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-538-5697
Provider Business Mailing Address Fax Number:
256-538-0239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 CHESNUT BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-927-8539
Provider Business Practice Location Address Fax Number:
256-927-8588
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAVES
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-927-8539

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  101053 , 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: 0111497 . This is a "NABP#" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 100001380 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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