Healthcare Provider Details

I. General information

NPI: 1174674030
Provider Name (Legal Business Name): CITY DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LEWIS ST
EVERGREEN AL
36401-3317
US

IV. Provider business mailing address

110 LEWIS ST
EVERGREEN AL
36401-3317
US

V. Phone/Fax

Practice location:
  • Phone: 251-578-1050
  • Fax:
Mailing address:
  • Phone: 251-578-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102440
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number102440
License Number StateAL

VIII. Authorized Official

Name: MR. HOSEA R DAILEY
Title or Position: PRESIDENT
Credential: RPH
Phone: 251-578-1050