# FAYETTE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Joe Golden Drug
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740474204
- **Authorized official:** SUMMER WILSON (OWNER/PHARMACIST)
- **Authorized official phone:** (205) 712-1685

## Contact information

- **Practice address:** 13532 HIGHWAY 96, MILLPORT, AL 35576-2522
- **Practice address phone:** (205) 662-3817
- **Practice address fax:** (205) 662-4757
- **Mailing address:** PO BOX 408, MILLPORT, AL 35576-0408
- **Mailing address phone:** (205) 662-3817
- **Mailing address fax:** (205) 662-4757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 105645 | AL | Yes |

## Other

- **Enumeration date:** 08/28/2007
- **Last updated:** 02/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2138253 | PK | — |