MEDICARE: GILMER DRUG COMPANY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093866030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILMER DRUG COMPANY INC.

Provider Business Mailing Address
First Line	:	413 19TH STREET ENSLEY
Second Line	:	ENSLEY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1601
Country	:	US
Telephone Number	:	205-787-4671
Fax Number	:	205-788-0450

Provider Business Practice Location Address
First Line	:	413 19TH STREET ENSLEY
Second Line	:	ENSLEY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1601
Country	:	US
Telephone Number	:	205-787-4671
Fax Number	:	205-788-0450

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	TARA RATCLIFF
Credential	:
Telephone Number	:	318-376-4530

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	09/13/2019

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Directions to “GILMER DRUG COMPANY INC. ” Practice Location

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