Healthcare Provider Details

I. General information

NPI: 1376619205
Provider Name (Legal Business Name): DEUEL DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SPRINGHILL AVE
MOBILE AL
36607-2918
US

IV. Provider business mailing address

2710 SPRINGHILL AVE
MOBILE AL
36607-2918
US

V. Phone/Fax

Practice location:
  • Phone: 251-478-7607
  • Fax: 251-478-7498
Mailing address:
  • Phone: 251-478-7607
  • Fax: 251-478-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number103167
License Number StateAL

VIII. Authorized Official

Name: CHARLEY JAMES DEUEL
Title or Position: OWNER-MANAGER-PHARMACIST
Credential: RPH
Phone: 251-478-7607