Healthcare Provider Details

I. General information

NPI: 1457475444
Provider Name (Legal Business Name): CROSSVILLE DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15192 AL HIGHWAY 68
CROSSVILLE AL
35962-3452
US

IV. Provider business mailing address

PO BOX 37
CROSSVILLE AL
35962-0037
US

V. Phone/Fax

Practice location:
  • Phone: 256-528-7124
  • Fax:
Mailing address:
  • Phone: 256-528-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25 02907
License Number StateAL

VIII. Authorized Official

Name: JAMES A GARDNER
Title or Position: PHARMACIST
Credential: RPH
Phone: 256-528-7124