Healthcare Provider Details

I. General information

NPI: 1659369825
Provider Name (Legal Business Name): MAIN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 PRAIRIE ST N
UNION SPRINGS AL
36089-1417
US

IV. Provider business mailing address

PO BOX 432
UNION SPRINGS AL
36089-0432
US

V. Phone/Fax

Practice location:
  • Phone: 334-738-2020
  • Fax: 334-738-8050
Mailing address:
  • Phone:
  • 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 Number106460
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MAIN
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 334-738-2020