Healthcare Provider Details

I. General information

NPI: 1497139497
Provider Name (Legal Business Name): KC DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40870 AL HIGHWAY 69 STE D
MOUNDVILLE AL
35474-4366
US

IV. Provider business mailing address

40870 AL HIGHWAY 69 STE D
MOUNDVILLE AL
35474-4366
US

V. Phone/Fax

Practice location:
  • Phone: 205-371-8755
  • Fax: 205-371-8756
Mailing address:
  • Phone: 205-371-8755
  • Fax: 205-371-8756

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 Number114505
License Number StateAL

VIII. Authorized Official

Name: KIMBERLY CREWS
Title or Position: RPH/OWNER
Credential:
Phone: 256-404-8582