Healthcare Provider Details

I. General information

NPI: 1407061526
Provider Name (Legal Business Name): MILLRY DRUGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30282 HWY 17 N
MILLRY AL
36558
US

IV. Provider business mailing address

PO BOX 199
MILLRY AL
36558-0199
US

V. Phone/Fax

Practice location:
  • Phone: 251-846-6290
  • Fax: 251-846-6208
Mailing address:
  • Phone: 251-846-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111191
License Number StateAL

VIII. Authorized Official

Name: SHARON THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-846-6208