Healthcare Provider Details

I. General information

NPI: 1679605984
Provider Name (Legal Business Name): LITTLE DRUG COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST S
LINDEN AL
36748
US

IV. Provider business mailing address

PO BOX 480999
LINDEN AL
36748-0999
US

V. Phone/Fax

Practice location:
  • Phone: 334-295-4270
  • Fax: 334-295-0141
Mailing address:
  • Phone: 334-295-4270
  • Fax: 334-295-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112401
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number112401
License Number StateAL

VIII. Authorized Official

Name: MR. RICHARD LAMAR BOONE
Title or Position: OWNER
Credential: R.PH.
Phone: 334-295-4270