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General NPI Number Information
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NPI Number | 1508918301
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Entity Type | Organization
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Legal Business Name | AUSTIN DRUG CO INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2422 DANVILLE RD SW STE J
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City | DECATUR
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State | AL
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Zip | 35603-4221
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Country | US
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Telephone | 256-353-1121
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Fax | 256-353-1790
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Provider Business Mailing Address
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Address Line | 2422 DANVILLE RD SW STE J
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City | DECATUR
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State | AL
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Zip | 35603-4221
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Country | US
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Telephone | 256-353-1121
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Fax | 256-353-1790
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL MARION COSTELLO
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Credential | PHARMACIST
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Telephone | 256-353-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 111104
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License Number State | AL
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