Healthcare Provider Details

I. General information

NPI: 1225134133
Provider Name (Legal Business Name): EMM DEE DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W MARKET ST
ATHENS AL
35611-2456
US

IV. Provider business mailing address

705 W MARKET ST
ATHENS AL
35611-2456
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-2242
  • Fax: 256-230-2613
Mailing address:
  • Phone: 256-232-2242
  • Fax: 256-230-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number101280
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN MAUND
Title or Position: OWNER
Credential: RPH
Phone: 256-232-2242