Healthcare Provider Details

I. General information

NPI: 1609634930
Provider Name (Legal Business Name): WIREGRASS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BROADWAY ST
ASHFORD AL
36312
US

IV. Provider business mailing address

PO BOX 72188
ALBANY GA
31708-2188
US

V. Phone/Fax

Practice location:
  • Phone: 334-899-3100
  • Fax: 334-899-3186
Mailing address:
  • Phone: 229-435-4571
  • Fax: 229-878-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRACY C ALLIGOOD
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 229-435-4571