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General NPI Number Information
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NPI Number | 1265503825
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Entity Type | Organization
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Legal Business Name | NORTHCUTTS DRUG COMPANY INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1774 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-1318
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Country | US
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Telephone | 334-793-9538
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Fax | 334-677-0898
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Provider Business Mailing Address
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Address Line | PO BOX 219
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City | DOTHAN
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State | AL
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Zip | 36302-0219
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Country | US
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Telephone | 334-793-9538
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Fax | 334-677-0898
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CLARENCE GLENN NORTHCUTT
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Credential | R.PH.
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Telephone | 334-793-9538
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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 | 5454
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License Number State | AL
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