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General NPI Number Information
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NPI Number | 1235198730
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Entity Type | Organization
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Legal Business Name | THE DRUG SHOP LLC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 104 MONTGOMERY ST SW
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City | RUSSELLVILLE
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State | AL
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Zip | 35653
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Country | US
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Telephone | 256-332-3022
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Fax | 256-332-3036
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Provider Business Mailing Address
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Address Line | 104 MONTGOMERY ST SW
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City | RUSSELLVILLE
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State | AL
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Zip | 35653
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Country | US
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Telephone | 256-332-3022
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Fax | 256-332-3036
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Authorized Official
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Title or Position | OWNER RPH
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Name | MR. JIMMY GREG LANE
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Credential |
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Telephone | 256-332-4021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 110481
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License Number State | AL
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