Healthcare Provider Details

I. General information

NPI: 1467547562
Provider Name (Legal Business Name): CITY DRUGS OF GROVE HILL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S. JACKSON ST
GROVE HILL AL
36451
US

IV. Provider business mailing address

123 S. JACKSON ST
GROVE HILL AL
36451
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3416
  • Fax: 251-275-8190
Mailing address:
  • Phone: 251-275-3416
  • Fax: 251-275-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number102420
License Number StateAL

VIII. Authorized Official

Name: MR. DALE D. HARRIS
Title or Position: PRESIDENT, MANAGER
Credential: R.PH.
Phone: 251-275-3512