=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689721946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAYLESS DRUGS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2512 31ST AVE N
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35207-4424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-252-4179
-----------------------------------------------------
Fax | 205-252-4170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2512 31ST AVE N
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35207-4424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-252-4179
-----------------------------------------------------
Fax | 205-252-4170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARTHUR BOYD ENNIS JR.
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 205-252-4179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 107678
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------