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Organization
BAYOU PHARMACY LLC
Active
Organization
BAYOU PHARMACY LLC
Active
Other names
Bayou Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES COTTRELL (PRESIDENT/PHARMACIST)
(251) 824-7979
Entity
Organization
Contact information
Practice address
12855 PADGETT SWITCH RD, IRVINGTON, AL 36544-4015
(251) 824-7979
(251) 824-7989
Mailing address
PO BOX 129, GRAND BAY, AL 36541-0129
(251) 865-1040
(251) 865-1041
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
113326
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114666
—
AL
01
—
2122525
PK
—
Enumeration date
10/19/2009
Last updated
10/18/2024
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