# BAYOU PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bayou Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629304183
- **Authorized official:** CHARLES COTTRELL (PRESIDENT/PHARMACIST)
- **Authorized official phone:** (251) 824-7979

## Contact information

- **Practice address:** 12855 PADGETT SWITCH RD, IRVINGTON, AL 36544-4015
- **Practice address phone:** (251) 824-7979
- **Practice address fax:** (251) 824-7989
- **Mailing address:** PO BOX 129, GRAND BAY, AL 36541-0129
- **Mailing address phone:** (251) 865-1040
- **Mailing address fax:** (251) 865-1041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 113326 | AL | Yes |

## Other

- **Enumeration date:** 10/19/2009
- **Last updated:** 10/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 114666 | — | AL |
| 01 | — | 2122525 | PK | — |