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General NPI Number Information
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NPI Number | 1487763447
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Entity Type | Organization
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Legal Business Name | VALLEY DRUG COMPANY #2
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 16TH AVE. SE
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City | DECATUR
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State | AL
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Zip | 35601-3594
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Country | US
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Telephone | 256-355-6225
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 16TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-3594
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Country | US
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Telephone | 256-355-6225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUSTAFA ISSA ELAYAN
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Credential |
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Telephone | 256-355-6225
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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 | 109885
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License Number State | AL
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