=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942750153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C & L DRUG COMPANY OF CULLMAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 10/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 4TH AVE NE
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-734-6013
-----------------------------------------------------
Fax | 256-734-6458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 4TH AVE NE
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-734-6013
-----------------------------------------------------
Fax | 256-734-6458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | REX SMITH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 256-734-6013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 105290
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------