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General NPI Number Information
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NPI Number | 1821092230
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Entity Type | Organization
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Legal Business Name | BOAZ DISCOUNT DRUGS INC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 10460 ALABAMA HWY 168, SUITE 1
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City | BOAZ
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State | AL
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Zip | 35957-1951
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Country | US
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Telephone | 256-593-6546
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Fax | 256-593-3137
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Provider Business Mailing Address
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Address Line | PO BOX 573
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City | BOAZ
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State | AL
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Zip | 35957-0573
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Country | US
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Telephone | 256-593-6546
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Fax | 256-593-3137
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARY DALE JOHNSON III
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Credential |
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Telephone | 256-593-6546
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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 | 101645
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License Number State | AL
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