Healthcare Provider Details

I. General information

NPI: 1285789255
Provider Name (Legal Business Name): EUTAW DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PRAIRIE AVE
EUTAW AL
35462-1174
US

IV. Provider business mailing address

PO BOX 390
EUTAW AL
35462-0390
US

V. Phone/Fax

Practice location:
  • Phone: 205-372-3346
  • Fax: 205-372-0639
Mailing address:
  • Phone: 205-372-3346
  • Fax: 205-372-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7662
License Number StateAL

VIII. Authorized Official

Name: CECIL NORMAN DURRETT
Title or Position: CHIEF PHARMACISTS
Credential: RPH
Phone: 205-372-3346