Healthcare Provider Details

I. General information

NPI: 1871587915
Provider Name (Legal Business Name): COLLEGE CITY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 WASHINGTON ST
MARION AL
36756-2332
US

IV. Provider business mailing address

PO BOX 220
MARION AL
36756-0220
US

V. Phone/Fax

Practice location:
  • Phone: 334-683-6166
  • Fax: 334-683-9621
Mailing address:
  • Phone: 334-683-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102640
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number102640
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number102640
License Number StateAL

VIII. Authorized Official

Name: BRADFORD ROGERS STURGIS
Title or Position: PRESIDENT-CHIEF PHARMACIST
Credential: RPH
Phone: 334-683-6166