Healthcare Provider Details

I. General information

NPI: 1508832932
Provider Name (Legal Business Name): WIREGRASS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E PUSHMATAHA ST
BUTLER AL
36904-2533
US

IV. Provider business mailing address

PO BOX 72188
ALBANY GA
31708-2188
US

V. Phone/Fax

Practice location:
  • Phone: 205-459-3710
  • Fax: 205-459-3970
Mailing address:
  • Phone: 229-435-4571
  • Fax: 229-317-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number110125
License Number StateAL

VIII. Authorized Official

Name: TRACY C ALLIGOOD
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 229-435-4571