Healthcare Provider Details

I. General information

NPI: 1699233114
Provider Name (Legal Business Name): YOUNGS DRUG STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24460 HIGHWAY 48
WOODLAND AL
36280-5204
US

IV. Provider business mailing address

PO BOX 67
LINEVILLE AL
36266-0067
US

V. Phone/Fax

Practice location:
  • Phone: 256-449-2372
  • Fax: 256-449-2379
Mailing address:
  • Phone: 256-396-5632
  • Fax: 256-396-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC STANLEY SMITH
Title or Position: MANGER
Credential:
Phone: 256-449-2372