Healthcare Provider Details

I. General information

NPI: 1174723555
Provider Name (Legal Business Name): THE DRUG STORE CO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LAFAYETTE STREET
LIVINGSTON AL
35470-0000
US

IV. Provider business mailing address

108 LAFAYETTE STREET PO BOX 1246
LIVINGSTON AL
35470-0000
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-9595
  • Fax: 205-652-6111
Mailing address:
  • Phone: 205-652-9595
  • Fax: 205-652-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number112084
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number112084
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number112084
License Number StateAL

VIII. Authorized Official

Name: LEE E DAVIS
Title or Position: OWNER
Credential:
Phone: 205-652-9595