Healthcare Provider Details

I. General information

NPI: 1770635021
Provider Name (Legal Business Name): HANCEVILLE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COMMERCIAL ST SE
HANCEVILLE AL
35077-5516
US

IV. Provider business mailing address

101 COMMERCIAL ST SE
HANCEVILLE AL
35077-5516
US

V. Phone/Fax

Practice location:
  • Phone: 256-352-4110
  • Fax: 256-352-5660
Mailing address:
  • Phone: 256-352-4110
  • Fax: 256-352-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number105010
License Number StateAL

VIII. Authorized Official

Name: BENJAMIN BURKART
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 256-352-4110