Healthcare Provider Details

I. General information

NPI: 1396410551
Provider Name (Legal Business Name): HURTSBORO DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 09/07/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MAIN ST
HURTSBORO AL
36860
US

IV. Provider business mailing address

PO BOX 327
HURTSBORO AL
36860-0327
US

V. Phone/Fax

Practice location:
  • Phone: 334-560-1329
  • Fax: 334-560-1392
Mailing address:
  • Phone: 334-560-1329
  • Fax: 334-560-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYLEN CREWS
Title or Position: OWNER
Credential: PHARMD
Phone: 334-560-1329