Organization
FORT DEPOSIT DRUG PHARMACY LLC
Active
Other names
FORT DEPOSIT DRUG PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH HAYES (PRESIDENT)
(205) 401-7911
Entity
Organization
Contact information
Practice address
120 S POLLARD ST, FORT DEPOSIT, AL 36032-3825
(334) 227-7777
(334) 227-4466
Mailing address
PO BOX 280, FORT DEPOSIT, AL 36032-0280
(334) 227-7777
(334) 227-4466
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113013
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0135029
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
113013
—
AL
Enumeration date
01/08/2008
Last updated
05/25/2011
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