Healthcare Provider Details

I. General information

NPI: 1821092230
Provider Name (Legal Business Name): BOAZ DISCOUNT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10460 ALABAMA HWY 168, SUITE 1
BOAZ AL
35957-1951
US

IV. Provider business mailing address

PO BOX 573
BOAZ AL
35957-0573
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-6546
  • Fax: 256-593-3137
Mailing address:
  • Phone: 256-593-6546
  • Fax: 256-593-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number101645
License Number StateAL

VIII. Authorized Official

Name: MR. CARY DALE JOHNSON III
Title or Position: PRESIDENT
Credential:
Phone: 256-593-6546