Healthcare Provider Details

I. General information

NPI: 1730779588
Provider Name (Legal Business Name): DRUG STORE AT STEVENSON ALABAMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 KENTUCKY AVE
STEVENSON AL
35772-3103
US

IV. Provider business mailing address

205 KENTUCKY AVE
STEVENSON AL
35772-3103
US

V. Phone/Fax

Practice location:
  • Phone: 256-437-6500
  • Fax: 256-437-6501
Mailing address:
  • Phone: 256-437-6500
  • Fax: 256-437-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier115028
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerSTATE PHARMACY LICENSE

VIII. Authorized Official

Name: EMILY PITTMAN LAYNE
Title or Position: OWNER/PHARMACIST
Credential: DOCTOR OF PHARMACY
Phone: 931-235-2000