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General NPI Number Information
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NPI Number | 1629304183
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Entity Type | Organization
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Legal Business Name | BAYOU PHARMACY LLC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 12855 PADGETT SWITCH RD
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City | IRVINGTON
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State | AL
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Zip | 36544-4015
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Country | US
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Telephone | 251-824-7979
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Fax | 251-824-7989
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | GRAND BAY
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State | AL
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Zip | 36541-0129
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Country | US
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Telephone | 251-865-1040
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Fax | 251-865-1041
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | CHARLES COTTRELL
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Credential |
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Telephone | 251-824-7979
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 113326
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License Number State | AL
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