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General NPI Number Information
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NPI Number | 1184738148
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Entity Type | Organization
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Legal Business Name | YOUNGS DRUG STORE LLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 88960 HWY 9
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City | LINEVILLE
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State | AL
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Zip | 36266
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Country | US
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Telephone | 256-396-5632
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Fax | 256-396-5142
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | LINEVILLE
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State | AL
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Zip | 36266-0067
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Country | US
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Telephone | 256-396-5632
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Fax | 256-396-5142
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Authorized Official
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Title or Position | MNGR, OWNER
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Name | ERIC SMITH
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Credential | RPH
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Telephone | 256-396-5632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12660
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License Number State | AL
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