Healthcare Provider Details

I. General information

NPI: 1053670687
Provider Name (Legal Business Name): BERRY DISCOUNT APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 DEPOT ST
BERRY AL
35546-2086
US

IV. Provider business mailing address

31 DEPOT ST P.O. BOX 424
BERRY AL
35546-2086
US

V. Phone/Fax

Practice location:
  • Phone: 205-689-4777
  • Fax: 205-689-4778
Mailing address:
  • Phone: 205-689-4777
  • Fax: 205-689-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. GEORGE R BOLLING JR.
Title or Position: OWNER
Credential: RPH
Phone: 205-689-4777