MEDICARE: COLLEGE CITY DRUGS 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	332B00000X	Durable Medical Equipment & Medical Supplies	102640	AL
2	3336L0003X	Long Term Care Pharmacy	102640	AL
3	3336C0003X	Community/Retail Pharmacy	102640	AL

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	:	1871587915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEGE CITY DRUGS INC

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-0220
Country	:	US
Telephone Number	:	334-683-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 WASHINGTON ST
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-2332
Country	:	US
Telephone Number	:	334-683-6166
Fax Number	:	334-683-9621

Authorized Official
Title or Position	:	PRESIDENT-CHIEF PHARMACIST
Name	:	BRADFORD ROGERS STURGIS
Credential	:	RPH
Telephone Number	:	334-683-6166

Provider Enumeration Date	:	09/05/2005
Last Update Date	:	09/27/2017

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Directions to “COLLEGE CITY DRUGS INC ” Practice Location

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