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General NPI Number Information
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NPI Number | 1740450535
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Entity Type | Organization
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Legal Business Name | X-TRA DISCOUNT DRUGS - MGY
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 7200 COPPERFIELD DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-7100
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Country | US
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Telephone | 334-277-7727
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Fax | 334-277-9599
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Provider Business Mailing Address
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Address Line | 7200 COPPERFIELD DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-7100
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Country | US
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Telephone | 334-277-7727
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Fax | 334-277-9599
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. ELIZABETH DAWN PEREA
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Credential | PHARM D
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Telephone | 334-277-7727
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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 |
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License Number State |
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