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NPI Code Detail

MEDICARE: NEW GRAND BAY PHARMACY, LLC

MEDICARE: NEW GRAND BAY PHARMACY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy113415AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467766865
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW GRAND BAY PHARMACY, LLC
Provider Business Mailing Address
First Line : PO BOX 129
Second Line :
City : GRAND BAY
State : AL
Zip : 36541-0129
Country : US
Telephone Number : 251-865-1040
Fax Number : 251-865-1041
Provider Business Practice Location Address
First Line : 10067 GRAND BAY WILMER RD S
Second Line :
City : GRAND BAY
State : AL
Zip : 36541-5003
Country : US
Telephone Number : 251-865-5555
Fax Number : 251-865-3785
Authorized Official
Title or Position : PRESIDENT
Name : MR. CHARLES D COTTRELL
Credential : RPH
Telephone Number : 251-865-5555
Provider Enumeration Date : 07/28/2010
Last Update Date : 10/18/2024

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Directions to “NEW GRAND BAY PHARMACY, LLC ” Practice Location

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