Healthcare Provider Details

I. General information

NPI: 1912098484
Provider Name (Legal Business Name): DEG PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30910 HWY 278
ADDISON AL
35540
US

IV. Provider business mailing address

PO BOX 180 30910 HWY 278
ADDISON AL
35540
US

V. Phone/Fax

Practice location:
  • Phone: 256-747-6342
  • Fax: 256-747-6106
Mailing address:
  • Phone: 256-747-6342
  • Fax: 256-747-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number111247
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0117362
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP NABP

VIII. Authorized Official

Name: DAVID GODBEE
Title or Position: OWNER PRES MGR
Credential: R PH
Phone: 256-747-6342