Healthcare Provider Details

I. General information

NPI: 1871622555
Provider Name (Legal Business Name): CITRONELLE DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19240 MOBILE ST
CITRONELLE AL
36522
US

IV. Provider business mailing address

PO BOX 386
CITRONELLE AL
36522-0386
US

V. Phone/Fax

Practice location:
  • Phone: 251-866-5522
  • Fax: 251-866-2335
Mailing address:
  • Phone: 251-866-5522
  • Fax: 251-866-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10811
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WAYNE JEFFUS
Title or Position: PRESIDENT OWNER PHARMACIST
Credential: RPH
Phone: 251-866-5522